Healthcare Provider Details

I. General information

NPI: 1598492381
Provider Name (Legal Business Name): KATRINA KUTTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23715 NE HIGHWAY 314
SALT SPRINGS FL
32134-6239
US

IV. Provider business mailing address

332 CAPTIVA DR
PONTE VEDRA FL
32081-5071
US

V. Phone/Fax

Practice location:
  • Phone: 352-414-1644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11018567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: