Provider Demographics
NPI:1174141063
Name:TROTTER-BOOKER, EBONY TOCCARA (RN)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:TOCCARA
Last Name:TROTTER-BOOKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 BRYANT IRVIN RD APT 3110
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3859
Mailing Address - Country:US
Mailing Address - Phone:808-740-4640
Mailing Address - Fax:
Practice Address - Street 1:5202 BRYANT IRVIN RD APT 3110
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3859
Practice Address - Country:US
Practice Address - Phone:808-740-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN-177326163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse