Provider Demographics
NPI:1962463885
Name:CARTER, PENELOPE LINDA (ARNP)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:LINDA
Last Name:CARTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 MAR WALT DR
Mailing Address - Street 2:SUITE 2021
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6960
Mailing Address - Country:US
Mailing Address - Phone:850-863-0006
Mailing Address - Fax:
Practice Address - Street 1:907 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6960
Practice Address - Country:US
Practice Address - Phone:850-863-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1514312363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033400600Medicaid
FL033400600Medicaid
FLP01499Medicare UPIN