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Individual

EBONIE PUERTOS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
4100 E FLETCHER AVE, TAMPA, FL 33613-4864
(813) 977-4950
Mailing address
4735 SOUTHBREEZE DR, TAMPA, FL 33624-1633

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9501623
FL

Other

Enumeration date
01/13/2021
Last updated
01/13/2021
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