Provider Demographics
NPI:1245088731
Name:CARTER, TYNISHA N (LPN, CPT)
Entity type:Individual
Prefix:
First Name:TYNISHA
Middle Name:N
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 E WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-1607
Mailing Address - Country:US
Mailing Address - Phone:484-350-5204
Mailing Address - Fax:
Practice Address - Street 1:1513 E WALNUT LN
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19138-1607
Practice Address - Country:US
Practice Address - Phone:484-350-5204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAS3X7J3H5246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty