MEDICARE: COLLEEN K SUTTER ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9180604	FL

General Provider Information

NPI Number	:	1013054634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN K SUTTER ARNP

Provider Business Mailing Address
First Line	:	1800 THE GREENS WAY APT 1102
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-2429
Country	:	US
Telephone Number	:	904-398-4700
Fax Number	:	904-493-9700

Provider Business Practice Location Address
First Line	:	4057 ATLANTIC BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207
Country	:	US
Telephone Number	:	904-493-9701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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