MEDICARE: DR. DEEDEE CARTER-SAKS LNP, DNP

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	9461377	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982903621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEDEE CARTER-SAKS LNP, DNP

Provider Business Mailing Address
First Line	:	4909 BLACKHAWK DR
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-2171
Country	:	US
Telephone Number	:	414-916-1827
Fax Number	:

Provider Business Practice Location Address
First Line	:	11363 SAN JOSE BLVD STE 102B
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-7958
Country	:	US
Telephone Number	:	904-288-8994
Fax Number	:	904-288-8995

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

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	12/14/2020

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