Provider Demographics
NPI:1033163456
Name:SHAFFER, LORETTA J (APRN)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:J
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:J
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:1624 MAIN STREET
Mailing Address - Street 2:AGAPE SENIOR PRIMARY CARE INC
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2818
Mailing Address - Country:US
Mailing Address - Phone:803-726-2350
Mailing Address - Fax:803-753-9102
Practice Address - Street 1:2601 FOREST DRIVE
Practice Address - Street 2:AGAPE SENIOR PRIMARY CARE INC
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2363
Practice Address - Country:US
Practice Address - Phone:803-491-0909
Practice Address - Fax:843-353-2581
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2832OtherSC BD OF NURSING LIC #