Healthcare Provider Details

I. General information

NPI: 1316918329
Provider Name (Legal Business Name): JILL MARIE SHUTES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 JOG RD SUITE 205
DELRAY BEACH FL
33446-2162
US

IV. Provider business mailing address

376 OLD COUNTRY RD
WELLINGTON FL
33414-4808
US

V. Phone/Fax

Practice location:
  • Phone: 561-496-7200
  • Fax:
Mailing address:
  • Phone: 561-797-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number9178369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: