MEDICARE: ROBERT TYLER LUTTINGER

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	363LF0000X	Family Nurse Practitioner	APRN11028537	FL

General Provider Information

NPI Number	:	1821875048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT TYLER LUTTINGER

Provider Business Mailing Address
First Line	:	511 SE 5TH AVE APT 803
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2968
Country	:	US
Telephone Number	:	954-707-0204
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 SE 5TH AVE APT 803
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2968
Country	:	US
Telephone Number	:	954-707-0204
Fax Number	:

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

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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