Healthcare Provider Details

I. General information

NPI: 1972322378
Provider Name (Legal Business Name): DENISE MARIE LOVEALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

IV. Provider business mailing address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

V. Phone/Fax

Practice location:
  • Phone: 904-270-4294
  • Fax: 904-270-4453
Mailing address:
  • Phone: 904-270-4294
  • Fax: 904-270-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9165057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: