Healthcare Provider Details

I. General information

NPI: 1649745035
Provider Name (Legal Business Name): LOVELOCK ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 N WICKHAM RD
MELBOURNE FL
32940-8367
US

IV. Provider business mailing address

PO BOX 486
LAKE FOREST IL
60045-0486
US

V. Phone/Fax

Practice location:
  • Phone: 239-246-0512
  • Fax:
Mailing address:
  • Phone: 800-444-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILFRED ROBIN LOVELOCK
Title or Position: MANAGER
Credential: CRNA
Phone: 239-246-0512