Provider Demographics
NPI:1902031362
Name:CARTER, SANDRA (AP, DOM)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 W ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-3639
Mailing Address - Country:US
Mailing Address - Phone:813-513-2923
Mailing Address - Fax:
Practice Address - Street 1:4230 S MACDILL AVE STE F
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1901
Practice Address - Country:US
Practice Address - Phone:813-513-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4916225700000X
FLAP3388171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist