Provider Demographics
NPI:1255921706
Name:CARTER, TAMRA BIBBY (LPN)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:BIBBY
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:MOLINO
Mailing Address - State:FL
Mailing Address - Zip Code:32577-0158
Mailing Address - Country:US
Mailing Address - Phone:352-209-5202
Mailing Address - Fax:844-230-3867
Practice Address - Street 1:1020 MCKINNONVILLE ST
Practice Address - Street 2:
Practice Address - City:MOLINO
Practice Address - State:FL
Practice Address - Zip Code:32577
Practice Address - Country:US
Practice Address - Phone:352-209-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1252681164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse