Provider Demographics
NPI:1750689386
Name:CARTER, TANIKA CHANTA (CCMA)
Entity Type:Individual
Prefix:MS
First Name:TANIKA
Middle Name:CHANTA
Last Name:CARTER
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10811 ROBERT E. LEE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-4550
Mailing Address - Country:US
Mailing Address - Phone:540-419-3399
Mailing Address - Fax:
Practice Address - Street 1:10811 ROBERT E. LEE DRIVE
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22551-4550
Practice Address - Country:US
Practice Address - Phone:540-419-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA03223498374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide