Provider Demographics
NPI:1891309605
Name:LOFTIN, JEANETTE D (HOME SITTER/CAREGIVE)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:D
Last Name:LOFTIN
Suffix:
Gender:F
Credentials:HOME SITTER/CAREGIVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50632
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-0632
Mailing Address - Country:US
Mailing Address - Phone:251-209-6319
Mailing Address - Fax:
Practice Address - Street 1:500 OAK DRIVE CT
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-3872
Practice Address - Country:US
Practice Address - Phone:251-209-6319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6508906172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker