Individual
EBONY N PRATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3465 VILLAGE CENTER DR, UFJP BRENTWOOD, JACKSONVILLE, FL 32206-8617
(904) 355-1893
(904) 355-1818
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
23590
AL
207Q00000X
Family Medicine Physician
Primary
ME77430
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2774020-00
—
FL
Enumeration date
04/06/2006
Last updated
04/22/2009
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