Provider Demographics
NPI:1710782818
Name:LOVE, MIA PATRICIA (CRNP)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:PATRICIA
Last Name:LOVE
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 HIGHLANDS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7681
Mailing Address - Country:US
Mailing Address - Phone:717-627-4088
Mailing Address - Fax:717-627-4089
Practice Address - Street 1:1535 HIGHLANDS DR STE 100
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7681
Practice Address - Country:US
Practice Address - Phone:717-627-4088
Practice Address - Fax:717-627-4089
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030510363LG0600X, 363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care