Provider Demographics
NPI:1396204749
Name:CARPENTER, ROBERTA A (NP-C)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:A
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 STATE ROUTE 33 STE 114
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6121
Mailing Address - Country:US
Mailing Address - Phone:732-455-3030
Mailing Address - Fax:
Practice Address - Street 1:2240 STATE ROUTE 33 STE 114
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-6121
Practice Address - Country:US
Practice Address - Phone:732-455-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00902000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily