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General NPI Number Information
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NPI Number | 1801619051
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Entity Type | Individual
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Provider Name | ANISA CUTUK APRN
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Gender | Female
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 905 PARK AVE STE 102
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City | ORANGE PARK
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State | FL
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Zip | 32073-4110
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Country | US
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Telephone | 904-736-2335
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Fax | 904-736-2336
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Provider Business Mailing Address
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Address Line | 10834 BIRCHARD LN
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City | JACKSONVILLE
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State | FL
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Zip | 32257-6950
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Country | US
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Telephone | 404-503-5917
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN11034184
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License Number State | FL
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