Healthcare Provider Details

I. General information

NPI: 1275185803
Provider Name (Legal Business Name): SHEILA TUTUWAH OWUSU MSN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST BLDG 502
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

5155 N LENA DR
BEVERLY HILLS FL
34465-4544
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-0549
  • Fax:
Mailing address:
  • Phone: 352-559-8591
  • Fax: 352-559-8592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704428920
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP11001953
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11117
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11001953
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704428920
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number312077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: