Provider Demographics
NPI:1861835589
Name:LOVELACE, CARLA J (CST/CSFA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 PARK CENTRAL
Mailing Address - Street 2:814
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7947
Mailing Address - Country:US
Mailing Address - Phone:972-801-7895
Mailing Address - Fax:
Practice Address - Street 1:1701 PARK CENTRAL
Practice Address - Street 2:814
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7947
Practice Address - Country:US
Practice Address - Phone:972-801-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246ZC0007X246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant