MEDICARE: IDA JUTTING BELL NP

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	363L00000X	Nurse Practitioner	200493	ND
2	363L00000X	Nurse Practitioner	257346	MT
3	363L00000X	Nurse Practitioner	9257624	FL

General Provider Information

NPI Number	:	1710330733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDA JUTTING BELL NP

Provider Business Mailing Address
First Line	:	2580 PALM DR
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6557
Country	:	US
Telephone Number	:	386-316-8092
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 DUNLAWTON AVE STE 102
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4741
Country	:	US
Telephone Number	:	386-316-8092
Fax Number	:

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

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	03/12/2025

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