Provider Demographics
NPI:1952560708
Name:CARTER, JACQUELINE L (FNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SCHOOL HOUSE RD STE 26
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04472-3966
Mailing Address - Country:US
Mailing Address - Phone:207-702-9201
Mailing Address - Fax:207-702-9194
Practice Address - Street 1:21 SCHOOL HOUSE RD STE 26
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:ME
Practice Address - Zip Code:04472-3966
Practice Address - Country:US
Practice Address - Phone:207-702-9201
Practice Address - Fax:207-702-9194
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1952560708Medicaid