Provider Demographics
NPI:1265458970
Name:LOVE, VONDA MARIE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:VONDA
Middle Name:MARIE
Last Name:LOVE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5606
Mailing Address - Country:US
Mailing Address - Phone:727-456-8745
Mailing Address - Fax:317-450-6596
Practice Address - Street 1:2175 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698
Practice Address - Country:US
Practice Address - Phone:727-456-8745
Practice Address - Fax:317-450-6596
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9355822363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232230EEEEMedicare UPIN