Provider Demographics
NPI:1326552860
Name:MCCOY, EBONI GRACE (NP-C)
Entity type:Individual
Prefix:MS
First Name:EBONI
Middle Name:GRACE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7751 BELFORT PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6921
Mailing Address - Country:US
Mailing Address - Phone:904-372-3943
Mailing Address - Fax:
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:904-372-3943
Practice Address - Fax:904-212-1618
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5010062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner