Provider Demographics
NPI:1083913503
Name:LOVETT, KELLY ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:LOVETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12973 N TELECOM PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0907
Mailing Address - Country:US
Mailing Address - Phone:813-871-8111
Mailing Address - Fax:
Practice Address - Street 1:12973 N TELECOM PKWY STE 100
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0907
Practice Address - Country:US
Practice Address - Phone:813-871-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9253239363LA2200X
GARN298176363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health