Healthcare Provider Details

I. General information

NPI: 1417041674
Provider Name (Legal Business Name): ELIZABETH ALMA KUTZNER REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 N COURTENAY PKWY
MERRITT ISLAND FL
32953
US

IV. Provider business mailing address

2575 N COURTENAY PKWY
MERRITT ISLAND FL
32953
US

V. Phone/Fax

Practice location:
  • Phone: 321-639-5787
  • Fax: 321-639-5762
Mailing address:
  • Phone: 321-639-5787
  • Fax: 321-639-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN1779852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: