Healthcare Provider Details

I. General information

NPI: 1740932250
Provider Name (Legal Business Name): BLENDA A JONES CARTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 SE JEREMY PL
LAKE CITY FL
32025-3901
US

IV. Provider business mailing address

219 SE JEREMY PL
LAKE CITY FL
32025-3901
US

V. Phone/Fax

Practice location:
  • Phone: 386-438-4488
  • Fax:
Mailing address:
  • Phone: 386-438-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number9452947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: