Healthcare Provider Details

I. General information

NPI: 1083354948
Provider Name (Legal Business Name): JAMES DONATO TUTTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21808 STATE ROAD 54
LUTZ FL
33549-6923
US

IV. Provider business mailing address

1843 S GLENCOE ST
DENVER CO
80222-3918
US

V. Phone/Fax

Practice location:
  • Phone: 727-315-8612
  • Fax:
Mailing address:
  • Phone: 720-755-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA209532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: