Healthcare Provider Details

I. General information

NPI: 1437455342
Provider Name (Legal Business Name): CARLA CUTTER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 4TH ST S
JACKSONVILLE BEACH FL
32250-5201
US

IV. Provider business mailing address

507 4TH ST S
JACKSONVILLE BEACH FL
32250-5201
US

V. Phone/Fax

Practice location:
  • Phone: 904-588-5361
  • Fax: 866-531-8858
Mailing address:
  • Phone: 904-588-5361
  • Fax: 866-531-8858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberLMT#41496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: