Provider Demographics
NPI:1053774893
Name:CARTER, DANIEL STEVEN JR (PA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:STEVEN
Last Name:CARTER
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 12TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-5914
Mailing Address - Country:US
Mailing Address - Phone:727-272-9119
Mailing Address - Fax:727-202-8240
Practice Address - Street 1:4120 12TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-5914
Practice Address - Country:US
Practice Address - Phone:727-272-9119
Practice Address - Fax:727-202-8240
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109455363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAV9RKOtherBCBS
FL017298400Medicaid