Provider Demographics
NPI:1902668684
Name:HAMILTON, EBONI RACQIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:EBONI
Middle Name:RACQIA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 GLADIATOR CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5334
Mailing Address - Country:US
Mailing Address - Phone:561-797-5254
Mailing Address - Fax:
Practice Address - Street 1:4805 GLADIATOR CIR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-5334
Practice Address - Country:US
Practice Address - Phone:561-797-5254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine