Healthcare Provider Details

I. General information

NPI: 1396623880
Provider Name (Legal Business Name): JERIECE K LOVELACE APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 SW FOUNTAINVIEW BLVD
PORT SAINT LUCIE FL
34986-4535
US

IV. Provider business mailing address

1860 SW FOUNTAINVIEW BLVD
PORT SAINT LUCIE FL
34986-4535
US

V. Phone/Fax

Practice location:
  • Phone: 786-853-2864
  • Fax:
Mailing address:
  • Phone: 786-853-2864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11041846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: