Healthcare Provider Details

I. General information

NPI: 1013054634
Provider Name (Legal Business Name): COLLEEN K SUTTER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4057 ATLANTIC BLVD
JACKSONVILLE FL
32207
US

IV. Provider business mailing address

1800 THE GREENS WAY APT 1102
JACKSONVILLE BEACH FL
32250-2429
US

V. Phone/Fax

Practice location:
  • Phone: 904-493-9701
  • Fax:
Mailing address:
  • Phone: 904-398-4700
  • Fax: 904-493-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9180604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: