Provider Demographics
NPI:1811398597
Name:CARTER-PLAKE, DAVID (LM, CPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CARTER-PLAKE
Suffix:
Gender:M
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3102
Mailing Address - Country:US
Mailing Address - Phone:808-631-8612
Mailing Address - Fax:
Practice Address - Street 1:165 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3102
Practice Address - Country:US
Practice Address - Phone:407-878-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
FLMW469176B00000X
OHPN-100236-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Yes176B00000XOther Service ProvidersMidwife