MEDICARE: MRS. PENNY MARIE LOYA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2836	SC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2836	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APRN 2836	OTHER	SC	STATE LICENSE

General Provider Information

NPI Number	:	1215021399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PENNY MARIE LOYA FNP

Provider Business Mailing Address
First Line	:	1415 BLANDING ST STE 4
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2922
Country	:	US
Telephone Number	:	803-779-7500
Fax Number	:	803-779-7522

Provider Business Practice Location Address
First Line	:	1415 BLANDING ST STE 4
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2922
Country	:	US
Telephone Number	:	803-779-7500
Fax Number	:	803-779-7522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/01/2023

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