Provider Demographics
NPI:1770376436
Name:CARPENTER, DEVONI' I
Entity type:Individual
Prefix:
First Name:DEVONI'
Middle Name:I
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 RIVERSIDE AVENUE
Mailing Address - Street 2:SUITE 100 PMB1030
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202
Mailing Address - Country:US
Mailing Address - Phone:850-852-0843
Mailing Address - Fax:904-341-5018
Practice Address - Street 1:245 RIVERSIDE AVENUE
Practice Address - Street 2:SUITE 100 PMB1030
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202
Practice Address - Country:US
Practice Address - Phone:850-852-0843
Practice Address - Fax:904-341-5018
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6229519527DC246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy