Basic Information
| Provider Information | |||||||||
| NPI: | 1730387044 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARTER | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | NICHOLAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, ATC,LAT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 UNIVERSITY BLVD NORTH | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042567801 | ||||||||
| FaxNumber: | 9042567810 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 UNIVERSITY BLVD NORTH | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048587045 | ||||||||
| FaxNumber: | 9048587047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2007 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AL2702 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.