Provider Demographics
NPI:1326114885
Name:CARTER, TAMARA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4416
Mailing Address - Country:US
Mailing Address - Phone:322-380-0989
Mailing Address - Fax:
Practice Address - Street 1:6100 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4416
Practice Address - Country:US
Practice Address - Phone:986-322-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA235Z00000X
FLSA21796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00772186BMedicaid
GA300034046AMedicaid