Provider Demographics
NPI:1124012711
Name:CARTER, TYRA SHARRON (FAMILY NURSE PRACTIT)
Entity type:Individual
Prefix:
First Name:TYRA
Middle Name:SHARRON
Last Name:CARTER
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3247 HALCYON CT. SUITE A
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:410-241-3871
Mailing Address - Fax:
Practice Address - Street 1:3247 HALCYON CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3379
Practice Address - Country:US
Practice Address - Phone:410-241-3871
Practice Address - Fax:410-318-6430
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR135126363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ31286Medicare UPIN
Q31286Medicare UPIN
0082NL000Medicare ID - Type Unspecified