Provider Demographics
NPI:1952560708
Name:CARTER, JACQUELINE L (FNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WATER ST
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-5231
Mailing Address - Country:US
Mailing Address - Phone:207-374-2311
Mailing Address - Fax:207-374-3991
Practice Address - Street 1:57 WATER ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-5231
Practice Address - Country:US
Practice Address - Phone:207-374-2311
Practice Address - Fax:207-374-3991
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1952560708Medicaid