Provider Demographics
NPI:1326657586
Name:CARTER, LEVAN ANGELLA (RN9469214)
Entity Type:Individual
Prefix:MISS
First Name:LEVAN
Middle Name:ANGELLA
Last Name:CARTER
Suffix:
Gender:F
Credentials:RN9469214
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 SW RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5918
Mailing Address - Country:US
Mailing Address - Phone:305-788-0005
Mailing Address - Fax:
Practice Address - Street 1:339 SW RIDGECREST DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5918
Practice Address - Country:US
Practice Address - Phone:305-788-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities