Provider Demographics
NPI:1972890721
Name:JARVIS, NIVEA LAVINIA (NP-C)
Entity Type:Individual
Prefix:
First Name:NIVEA
Middle Name:LAVINIA
Last Name:JARVIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:NIVEA
Other - Middle Name:LAVINIA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:215 POINTERS RUN
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1445
Mailing Address - Country:US
Mailing Address - Phone:270-315-7003
Mailing Address - Fax:
Practice Address - Street 1:325 REGENCY RIDGE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4252
Practice Address - Country:US
Practice Address - Phone:937-436-3833
Practice Address - Fax:937-291-4562
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006943363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily