Provider Demographics
NPI:1871574012
Name:CARTER, JENNIFER REBECCA (APRN, BC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:REBECCA
Last Name:CARTER
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:REBECCA
Other - Last Name:STEENHOEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-0550
Mailing Address - Fax:239-343-4013
Practice Address - Street 1:13340 METRO PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966
Practice Address - Country:US
Practice Address - Phone:239-343-0550
Practice Address - Fax:239-343-0559
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9393880363LA2100X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00258822OtherRAILROAD MEDICARE
FL013788800Medicaid
MI4709512Medicaid
MID17643124Medicare PIN
MIQ41875Medicare UPIN