Provider Demographics
NPI:1386766020
Name:LOVELL, AMANDA RENEAU (LPN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RENEAU
Last Name:LOVELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 SEVILLA CT
Mailing Address - Street 2:APT 206
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920
Mailing Address - Country:US
Mailing Address - Phone:321-784-1597
Mailing Address - Fax:
Practice Address - Street 1:7008 SEVILLA CT
Practice Address - Street 2:APT 206
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920
Practice Address - Country:US
Practice Address - Phone:321-784-1597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN066259164W00000X
FLPN5161753164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse