Healthcare Provider Details

I. General information

NPI: 1518111012
Provider Name (Legal Business Name): JULIE DIANE CLUTE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W MIDWAY RD
FORT PIERCE FL
34981-4955
US

IV. Provider business mailing address

2900 W MIDWAY RD
FORT PIERCE FL
34981-4955
US

V. Phone/Fax

Practice location:
  • Phone: 772-467-0961
  • Fax: 772-467-6683
Mailing address:
  • Phone: 772-467-0961
  • Fax: 772-467-6683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9228610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: