Provider Demographics
NPI:1326657586
Name:CARTER, LEVAN ANGELLA (APRN11039417)
Entity type:Individual
Prefix:MISS
First Name:LEVAN
Middle Name:ANGELLA
Last Name:CARTER
Suffix:
Gender:F
Credentials:APRN11039417
Other - Prefix:
Other - First Name:LEVAN
Other - Middle Name:ANGELLA
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:339 SW RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5918
Mailing Address - Country:US
Mailing Address - Phone:305-788-0005
Mailing Address - Fax:
Practice Address - Street 1:339 SW RIDGECREST DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5918
Practice Address - Country:US
Practice Address - Phone:305-788-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11039417363LP0808X
261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health