MEDICARE: MR. JAMES EVAN CARPENTER FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024175496	VA
2	207Q00000X	Family Medicine Physician	9359202	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396256616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES EVAN CARPENTER FNP-BC

Provider Business Mailing Address
First Line	:	1111 LUCERNE TER
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-1016
Country	:	US
Telephone Number	:	407-250-9444
Fax Number	:	407-550-7611

Provider Business Practice Location Address
First Line	:	1111 LUCERNE TER
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-1016
Country	:	US
Telephone Number	:	407-250-9444
Fax Number	:	407-550-7611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2017
Last Update Date	:	10/11/2023

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