Provider Demographics
NPI:1225589179
Name:CARTER, RODNEY SHAWN (ARNP, FNP-C, MSN)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:SHAWN
Last Name:CARTER
Suffix:
Gender:M
Credentials:ARNP, FNP-C, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 ARCHAIC DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1676
Mailing Address - Country:US
Mailing Address - Phone:863-698-0816
Mailing Address - Fax:
Practice Address - Street 1:2125 CRYSTAL GROVE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6875
Practice Address - Country:US
Practice Address - Phone:863-688-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-16
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3357442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1225589179Medicaid
FL1225589179Medicare Oscar/Certification
FL1225589179Medicare PIN
FL1225589179Medicare UPIN
FL1225589179Medicare NSC