Provider Demographics
NPI:1497872394
Name:JARVIS, ERICKA FURRECE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:FURRECE
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 BURNING TREE DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-4667
Mailing Address - Country:US
Mailing Address - Phone:321-264-7560
Mailing Address - Fax:
Practice Address - Street 1:2020 BURNING TREE DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-4667
Practice Address - Country:US
Practice Address - Phone:321-264-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5166654164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse