Healthcare Provider Details

I. General information

NPI: 1124915400
Provider Name (Legal Business Name): ANILA KUTULLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5352 LINTON BLVD
DELRAY BEACH FL
33484-6514
US

IV. Provider business mailing address

5352 LINTON BLVD
DELRAY BEACH FL
33484-6514
US

V. Phone/Fax

Practice location:
  • Phone: 561-289-5666
  • Fax:
Mailing address:
  • Phone: 561-289-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11040335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: