Healthcare Provider Details

I. General information

NPI: 1407212467
Provider Name (Legal Business Name): AMANDA TUTLEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 OVERSEAS HWY #38
MARATHON FL
33050-2735
US

IV. Provider business mailing address

811 WHITE ST
KEY WEST FL
33040-7156
US

V. Phone/Fax

Practice location:
  • Phone: 305-743-7111
  • Fax:
Mailing address:
  • Phone: 219-776-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9392197
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: