Provider Demographics
NPI:1407495351
Name:LOVE, CONNIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CONCETTA
Other - Middle Name:
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:40 ABILENE DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-5305
Mailing Address - Country:US
Mailing Address - Phone:949-533-2759
Mailing Address - Fax:
Practice Address - Street 1:16200 SAND CANYON AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3714
Practice Address - Country:US
Practice Address - Phone:949-517-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-24
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009038363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner