Provider Demographics
NPI:1053869529
Name:ROLLINS, EBONY MONIQUE (ARNP)
Entity type:Individual
Prefix:MS
First Name:EBONY
Middle Name:MONIQUE
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BATES AVE SW STE 111
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-2920
Mailing Address - Country:US
Mailing Address - Phone:863-268-4626
Mailing Address - Fax:866-825-5809
Practice Address - Street 1:130 BATES AVE SW STE 111
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2920
Practice Address - Country:US
Practice Address - Phone:863-268-4626
Practice Address - Fax:866-825-5809
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9304982363LA2200X
FLARNP 9304982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019675100Medicaid