Healthcare Provider Details

I. General information

NPI: 1962463885
Provider Name (Legal Business Name): PENELOPE LINDA CARTER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 MAR WALT DR
FORT WALTON BEACH FL
32547-6960
US

IV. Provider business mailing address

907 MAR WALT DR SUITE 2021
FORT WALTON BEACH FL
32547-6960
US

V. Phone/Fax

Practice location:
  • Phone: 850-863-0006
  • Fax:
Mailing address:
  • Phone: 850-863-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberARNP1514312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: