Provider Demographics
NPI:1609425313
Name:LOVELACE, SHEILA MAUREEN
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MAUREEN
Last Name:LOVELACE
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 1:12831 JOE HARIG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-8162
Mailing Address - Country:US
Mailing Address - Phone:352-668-8646
Mailing Address - Fax:
Practice Address - Street 1:12831 JOE HARIG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:FL
Practice Address - Zip Code:33576-8162
Practice Address - Country:US
Practice Address - Phone:352-668-8646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider