Provider Demographics
NPI:1093376709
Name:CARTER, AMANDA (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 37TH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7305
Mailing Address - Country:US
Mailing Address - Phone:772-494-0794
Mailing Address - Fax:772-494-0745
Practice Address - Street 1:787 37TH ST STE 250
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7305
Practice Address - Country:US
Practice Address - Phone:772-494-0794
Practice Address - Fax:772-494-0745
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002877363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOG793OtherMEDICARE HF
FL103600400Medicaid