Healthcare Provider Details

I. General information

NPI: 1467373894
Provider Name (Legal Business Name): DEEANDREA CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 SW 121ST WAY
GAINESVILLE FL
32608-0225
US

IV. Provider business mailing address

900 CESERY BLVD STE 104B
JACKSONVILLE FL
32211-5634
US

V. Phone/Fax

Practice location:
  • Phone: 727-457-0101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: