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General NPI Number Information
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NPI Number | 1316918329
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Entity Type | Individual
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Provider Name | JILL MARIE SHUTES ARNP
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Gender | Female
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Dates
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Enumeration Date | 01/28/2006
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 15300 JOG RD SUITE 205
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2162
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Country | US
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Telephone | 561-496-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 376 OLD COUNTRY RD
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City | WELLINGTON
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State | FL
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Zip | 33414-4808
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Country | US
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Telephone | 561-797-5810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 9178369
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License Number State | FL
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