Jacqueline Ebony Ambush, PNP BC
Nurse Practitioner, Pediatrics in Baltimore, MD. Individual provider (NPI-1).
NPI number1013335546
StatusActive
Last updated in NPPESApr 29, 2026
Details
- NPI
- 1013335546
- Entity type
- Individual (NPI-1)
- Name
- Jacqueline Ebony Ambush
- Credential
- PNP BC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 2, 2014
- Certification date
- Apr 29, 2026
- Last updated
- Apr 29, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0200X | Nurse Practitioner, Pediatrics | R117755 | MD | Yes |
| 363LP2300X | Nurse Practitioner, Primary Care | R117755 | MD |
Practice location
4367 Hollins Ferry RdSte.1c
Baltimore, MD 21227-3400
Phone 410-707-5947
Mailing address
4367 Hollins Ferry Rd Ste 1cBaltimore, MD 21227-3400
Phone 410-707-5947 · Fax 410-609-6672
Other practice locations
5252 Hollister St Ste 203c
Houston, TX 77040-6214
Houston, TX 77040-6214
Phone 346-678-4442 · Fax 346-678-4442
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