Provider Demographics
NPI:1497309546
Name:LOVELLY, CARRIE RENEE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:RENEE
Last Name:LOVELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8168 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32220-2656
Mailing Address - Country:US
Mailing Address - Phone:904-999-7611
Mailing Address - Fax:
Practice Address - Street 1:8168 OREGON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32220-2656
Practice Address - Country:US
Practice Address - Phone:904-999-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide