Provider Demographics
NPI:1689096265
Name:LOVELAND, JENNIFER ANN (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:LOVELAND
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:TRAMUTOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1325 TRAVIS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4611
Mailing Address - Country:US
Mailing Address - Phone:707-429-8855
Mailing Address - Fax:
Practice Address - Street 1:1325 TRAVIS BLVD STE C
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4611
Practice Address - Country:US
Practice Address - Phone:707-429-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA814535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily