Provider Demographics
NPI:1033538707
Name:CARTER, JACQUELINE (ARNP, CNM)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 W SUNRISE BLVD STE A4
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5426
Mailing Address - Country:US
Mailing Address - Phone:954-805-8000
Mailing Address - Fax:
Practice Address - Street 1:8200 W SUNRISE BLVD STE A4
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5426
Practice Address - Country:US
Practice Address - Phone:954-805-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9272860367A00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife