Provider Demographics
NPI:1164072054
Name:CARTER, TIERRA JASMINE (RD LDN)
Entity Type:Individual
Prefix:MS
First Name:TIERRA
Middle Name:JASMINE
Last Name:CARTER
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3951 SW MCCRORY ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3970
Mailing Address - Country:US
Mailing Address - Phone:772-812-9168
Mailing Address - Fax:
Practice Address - Street 1:3951 SW MCCRORY ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3970
Practice Address - Country:US
Practice Address - Phone:772-812-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9056133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty