Provider Demographics
NPI:1629661871
Name:PURVIS, CHIQUITA JACQUELLE
Entity Type:Individual
Prefix:
First Name:CHIQUITA
Middle Name:JACQUELLE
Last Name:PURVIS
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 1:1664 LAKE WATEREE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8160
Mailing Address - Country:US
Mailing Address - Phone:843-536-2285
Mailing Address - Fax:
Practice Address - Street 1:1664 LAKE WATEREE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8160
Practice Address - Country:US
Practice Address - Phone:843-536-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)