Healthcare Provider Details

I. General information

NPI: 1174564843
Provider Name (Legal Business Name): MIKEL B. TUTEN PHARMD, CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2742 ENTERPRISE RD
ORANGE CITY FL
32763-8353
US

IV. Provider business mailing address

1731 MISSOURI AVE
SANFORD FL
32771-9722
US

V. Phone/Fax

Practice location:
  • Phone: 386-775-2255
  • Fax: 386-775-6773
Mailing address:
  • Phone: 407-324-2911
  • Fax: 407-324-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS18600
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH013672
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberPU2776
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberRPH013672
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: