Healthcare Provider Details

I. General information

NPI: 1083913503
Provider Name (Legal Business Name): KELLY ANN LOVETT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12973 N TELECOM PKWY STE 100
TEMPLE TERRACE FL
33637-0907
US

IV. Provider business mailing address

12973 N TELECOM PKWY STE 100
TEMPLE TERRACE FL
33637-0907
US

V. Phone/Fax

Practice location:
  • Phone: 813-871-8111
  • Fax:
Mailing address:
  • Phone: 813-871-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9253239
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN298176
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: