Provider Demographics
NPI:1649009960
Name:CARTER, MISCHA L (CNA)
Entity type:Individual
Prefix:
First Name:MISCHA
Middle Name:L
Last Name:CARTER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 IRON MILL TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5977
Mailing Address - Country:US
Mailing Address - Phone:904-504-4003
Mailing Address - Fax:
Practice Address - Street 1:8550 IRON MILL TRL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5977
Practice Address - Country:US
Practice Address - Phone:904-504-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA152587374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty