Jacqueline Ebony Ambush, PNP BC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R117755 Issued in MD

Practice address

4367 Hollins Ferry Rd
Ste.1C
Baltimore, MD 21227-3400

Phone

(410) 707-5947

NPI assigned

Apr 2, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ambush Lab

  • Adolescent Medicine (Family Medicine) Physician
  • Baltimore, MD
  • NPI 1295671311
  NPD Authorized official
• Ambush Pediatrics and Family Medical Clinic

  • Adolescent Medicine (Family Medicine) Physician
  • Halethorpe, MD
  • NPI 1457956948
  NPD Authorized official
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777420800000",
    "number": "1013335546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4367 HOLLINS FERRY RD STE 1C",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212273400",
            "telephone_number": "410-707-5947",
            "fax_number": "410-609-6672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4367 HOLLINS FERRY RD",
            "address_2": "STE.1C",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212273400",
            "telephone_number": "410-707-5947"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5252 Hollister St Ste 203C",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770406214",
            "country_code": "US",
            "telephone_number": "346-678-4442",
            "fax_number": "346-678-4442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AMBUSH",
        "first_name": "JACQUELINE",
        "middle_name": "EBONY",
        "credential": "PNP BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-02",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MD",
            "license": "R117755",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MD",
            "license": "R117755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND BOARD OF NURSING",
            "identifier": "R117755",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lara Ambrosi, MD
• Anthony Michael Ambrosino Jr., DC
• Christina Ambrosino
• Sarah Amburn, M.A, C.A.S
• Ambush Lab
• Ameen Services LLC
• Olubukola Ameen
• Paula Ameller
• Pamela Jayne Amelung, M.D.
• Amena Health & Rehabilitation Services

• Pediatric Nurse Practitioner in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Pediatric Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.