Provider Demographics
NPI:1215503941
Name:LOVING, CHIQUITA (NP)
Entity type:Individual
Prefix:
First Name:CHIQUITA
Middle Name:
Last Name:LOVING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHIQUITA
Other - Middle Name:
Other - Last Name:LOVING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:501 AVALON WAY STE C
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7500
Mailing Address - Country:US
Mailing Address - Phone:601-573-7012
Mailing Address - Fax:
Practice Address - Street 1:501 AVALON WAY STE C
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-7500
Practice Address - Country:US
Practice Address - Phone:601-573-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904304363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health