Ambush, Jacqueline Ebony

Ambush, Jacqueline Ebony is an individual health care provider with primary practice located at 4367 Hollins Ferry Rd Ste.1C, Baltimore MD 21227-3400. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Primary Care. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Ambush, Jacqueline Ebony can be contacted via phone (410) 707-5947.

Contact Information

Primary practice address
4367 Hollins Ferry Rd Ste.1C Baltimore MD 21227-3400
Phone: (410) 707-5947
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X R117755 Maryland
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X R117755 Maryland

Profile Details

NPI number 1013335546
LBN Legal business name Ambush, Jacqueline Ebony
Credentials PNP BC
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 2nd, 2014
Last updated Jun 1st, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013335546 NPPES
Maryland Other R117755 MARYLAND BOARD OF NURSING

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