MEDICARE: PATRICE GUTT APN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ01237700	NJ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11022493	FL

General Provider Information

NPI Number	:	1881170215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE GUTT APN

Provider Business Mailing Address
First Line	:	796 MOUNT PROSPECT AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-3223
Country	:	US
Telephone Number	:	908-267-4708
Fax Number	:

Provider Business Practice Location Address
First Line	:	796 MOUNT PROSPECT AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-3223
Country	:	US
Telephone Number	:	833-769-3524
Fax Number	:

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

Provider Enumeration Date	:	07/18/2018
Last Update Date	:	08/06/2025

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