MEDICARE: MISCHA L CARTER CNA

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	374U00000X	Home Health Aide	CNA152587	FL

General Provider Information

NPI Number	:	1649009960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISCHA L CARTER CNA

Provider Business Mailing Address
First Line	:	8550 IRON MILL TRL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5977
Country	:	US
Telephone Number	:	904-504-4003
Fax Number	:

Provider Business Practice Location Address
First Line	:	8550 IRON MILL TRL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5977
Country	:	US
Telephone Number	:	904-504-4003
Fax Number	:

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

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	08/07/2024

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