Healthcare Provider Details

I. General information

NPI: 1245134543
Provider Name (Legal Business Name): MS. HEATHER MICHELLE MCCUTCHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 N ORLANDO AVE
WINTER PARK FL
32789-2990
US

IV. Provider business mailing address

480 N ORLANDO AVE
WINTER PARK FL
32789-2990
US

V. Phone/Fax

Practice location:
  • Phone: 407-636-6363
  • Fax:
Mailing address:
  • Phone: 407-636-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11051381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: