Provider Demographics
NPI:1245975671
Name:CARTER, MICHELLE LYNN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:CARTER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12101 CHESTER TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2698
Mailing Address - Country:US
Mailing Address - Phone:765-465-3292
Mailing Address - Fax:
Practice Address - Street 1:205 CRYSTAL GROVE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-6449
Practice Address - Country:US
Practice Address - Phone:813-882-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9585973163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant