Provider Demographics
NPI:1982903621
Name:CARTER-SAKS, DEEDEE (LNP, DNP)
Entity type:Individual
Prefix:DR
First Name:DEEDEE
Middle Name:
Last Name:CARTER-SAKS
Suffix:
Gender:F
Credentials:LNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 BLACKHAWK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2171
Mailing Address - Country:US
Mailing Address - Phone:414-916-1827
Mailing Address - Fax:
Practice Address - Street 1:11363 SAN JOSE BLVD STE 102B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7958
Practice Address - Country:US
Practice Address - Phone:904-288-8994
Practice Address - Fax:904-288-8995
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9461377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982903621Medicaid