MEDICARE: JERIECE K LOVELACE APRN, PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11041846	FL

General Provider Information

NPI Number	:	1396623880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERIECE K LOVELACE APRN, PMHNP

Provider Business Mailing Address
First Line	:	1860 SW FOUNTAINVIEW BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-4535
Country	:	US
Telephone Number	:	786-853-2864
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 SW FOUNTAINVIEW BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-4535
Country	:	US
Telephone Number	:	786-853-2864
Fax Number	:

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

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	12/17/2025

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