Healthcare Provider Details

I. General information

NPI: 1588238711
Provider Name (Legal Business Name): JAMISON LUTEN APRN, CWOCN, CSWD-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 HIGHLAND MANOR DR STE 300
TAMPA FL
33610-9712
US

IV. Provider business mailing address

3923 FORT HAMILTON PKWY
BROOKLYN NY
11218-1916
US

V. Phone/Fax

Practice location:
  • Phone: 192-949-1770
  • Fax:
Mailing address:
  • Phone: 192-949-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11019650
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberPMD525524
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: