Provider Demographics
NPI:1396623880
Name:LOVELACE, JERIECE K (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:JERIECE
Middle Name:K
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 SW FOUNTAINVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4535
Mailing Address - Country:US
Mailing Address - Phone:786-853-2864
Mailing Address - Fax:
Practice Address - Street 1:1860 SW FOUNTAINVIEW BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-4535
Practice Address - Country:US
Practice Address - Phone:786-853-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11041846363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health