MEDICARE: MS. JILL MARIE SHUTES ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	9178369	FL

General Provider Information

NPI Number	:	1316918329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL MARIE SHUTES ARNP

Provider Business Mailing Address
First Line	:	376 OLD COUNTRY RD
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4808
Country	:	US
Telephone Number	:	561-797-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	15300 JOG RD
Second Line	:	SUITE 205
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2162
Country	:	US
Telephone Number	:	561-496-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	06/01/2012

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