Provider Demographics
NPI:1366057796
Name:CARTER, DJUANA M (LPN)
Entity type:Individual
Prefix:
First Name:DJUANA
Middle Name:M
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 LAKE CHAPMAN DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4169
Mailing Address - Country:US
Mailing Address - Phone:813-294-1152
Mailing Address - Fax:
Practice Address - Street 1:1837 LAKE CHAPMAN DR UNIT 202
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4169
Practice Address - Country:US
Practice Address - Phone:317-753-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27071661A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse