Provider Demographics
NPI:1013365626
Name:TUTTLE, REBECCA MARIE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 TIFFANY PINES CIR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-2591
Mailing Address - Country:US
Mailing Address - Phone:055-866-0443
Mailing Address - Fax:
Practice Address - Street 1:1746 TIFFANY PINES CIR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2591
Practice Address - Country:US
Practice Address - Phone:305-586-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSYC.00015169103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical