Healthcare Provider Details

I. General information

NPI: 1437552155
Provider Name (Legal Business Name): MARSHA LOFTIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 RIVER OAKS DR SUITE B-103
FLOWOOD MS
39232-9779
US

IV. Provider business mailing address

1080 RIVER OAKS DR SUITE B-103
FLOWOOD MS
39232-9779
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-1011
  • Fax: 601-932-6111
Mailing address:
  • Phone: 601-366-1011
  • Fax: 601-932-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR635995
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: