Provider Demographics
NPI:1023042298
Name:TRUELOVE, EDDIE JEAN (MSN, APRN, BC)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:JEAN
Last Name:TRUELOVE
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 US HIGHWAY 19 S APT 113
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4978
Mailing Address - Country:US
Mailing Address - Phone:901-603-5890
Mailing Address - Fax:
Practice Address - Street 1:1578 US HIGHWAY 19 S APT 113
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4978
Practice Address - Country:US
Practice Address - Phone:901-603-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022659363LP0808X
TX1064802363LP0808X
GARN212011363LP0808X
VA0024184382363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4136506OtherBLUE CROSS BLUE SHIELD
TNP00609180OtherRAILROAD MEDICARE
TN3642147Medicaid
Q59847Medicare UPIN
TN3642147Medicaid