Healthcare Provider Details

I. General information

NPI: 1215382619
Provider Name (Legal Business Name): ANDREA TUTTLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 QUINTETTE ROAD
PACE FL
32571
US

IV. Provider business mailing address

5755 QUINTETTE RD
PACE FL
32571-9711
US

V. Phone/Fax

Practice location:
  • Phone: 850-995-8087
  • Fax:
Mailing address:
  • Phone: 850-995-8087
  • Fax: 850-994-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME138414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: