Provider Demographics
NPI:1558025015
Name:LOVE, JILL SMITH (APRN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SMITH
Last Name:LOVE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 DELOS RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-5433
Mailing Address - Country:US
Mailing Address - Phone:843-372-8620
Mailing Address - Fax:
Practice Address - Street 1:1036 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-2827
Practice Address - Country:US
Practice Address - Phone:803-773-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily