Healthcare Provider Details

I. General information

NPI: 1639733876
Provider Name (Legal Business Name): JOY ANN OCUTO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30301 SW 198TH AVE
HOMESTEAD FL
33030-2623
US

IV. Provider business mailing address

30301 SW 198TH AVE
HOMESTEAD FL
33030-2623
US

V. Phone/Fax

Practice location:
  • Phone: 786-543-6005
  • Fax:
Mailing address:
  • Phone: 786-543-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN9336879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: