Provider Demographics
NPI:1740522267
Name:CARTER, TINA M (LVN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:CARTER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11950 BERKELEY DR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-3924
Mailing Address - Country:US
Mailing Address - Phone:909-213-0698
Mailing Address - Fax:
Practice Address - Street 1:11950 BERKELEY DR
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-3924
Practice Address - Country:US
Practice Address - Phone:909-790-7906
Practice Address - Fax:909-907-0728
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272191164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse