=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205953494
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNINE A. LOVELL SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 03/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11463 CORTEZ BLVD BROOKSVILLE REHAB 2000
-----------------------------------------------------
City | BROOKSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34613-7367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-592-1114
-----------------------------------------------------
Fax | 352-592-1190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3352 TRUMPETFISH LANE
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-5603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-238-0084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA 3737
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------