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General NPI Number Information
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NPI Number | 1578214169
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Entity Type | Individual
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Provider Name | AMY L CUTSHALL NP
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Gender | Female
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 1300 SW SAINT LUCIE WEST BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2109
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Country | US
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Telephone | 219-464-2141
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Fax |
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Provider Business Mailing Address
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Address Line | 11405 PLATTNER DR
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City | MOKENA
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State | IL
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Zip | 60448-9231
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Country | US
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Telephone | 219-333-6983
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71011990A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11034607
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License Number State | FL
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