Provider Demographics
NPI:1073070058
Name:MIMS-GONZALEZ, LOVIETRICE
Entity Type:Individual
Prefix:
First Name:LOVIETRICE
Middle Name:
Last Name:MIMS-GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOVIETRICE
Other - Middle Name:
Other - Last Name:MIMS-GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1330 WYNNEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-5642
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1330 WYNNEWOOD DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-5642
Practice Address - Country:US
Practice Address - Phone:407-572-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9368815163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse