Provider Demographics
NPI:1306237862
Name:WHITEHEAD-CARTER, TERESA
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:WHITEHEAD-CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 CANTON CIR APT 40
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-6569
Mailing Address - Country:US
Mailing Address - Phone:850-661-2708
Mailing Address - Fax:
Practice Address - Street 1:850 CANTON CIR APT 40
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-6569
Practice Address - Country:US
Practice Address - Phone:850-661-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA253489172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker