Provider Demographics
NPI:1619394863
Name:ERVIN, JENNIFER (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ERVIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 W EVANS ST
Mailing Address - Street 2:DHEC HOME HEALTH
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3331
Mailing Address - Country:US
Mailing Address - Phone:843-661-4762
Mailing Address - Fax:
Practice Address - Street 1:1705 W EVANS ST
Practice Address - Street 2:DHEC HOME HEALTH
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3331
Practice Address - Country:US
Practice Address - Phone:843-661-4762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC60088163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health