Healthcare Provider Details

I. General information

NPI: 1245461508
Provider Name (Legal Business Name): CLARENCE MICHAEL HUTTO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BAPTIST WAY STE 3C
PENSACOLA FL
32503-2274
US

IV. Provider business mailing address

1005 MAR WALT DRIVE IMMEDIATE CARE DEPARTMENT
FORT WALTON BEACH FL
32547-6796
US

V. Phone/Fax

Practice location:
  • Phone: 448-227-6500
  • Fax: 850-857-1747
Mailing address:
  • Phone: 850-863-8219
  • Fax: 850-863-8249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9171115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: