Provider Demographics
NPI:1124019831
Name:KUTZ, SHERRY COE (CRNA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:COE
Last Name:KUTZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:COE
Other - Last Name:PELLONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:160 CORAL VINE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5718
Mailing Address - Country:US
Mailing Address - Phone:239-249-0471
Mailing Address - Fax:
Practice Address - Street 1:160 CORAL VINE DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5718
Practice Address - Country:US
Practice Address - Phone:239-249-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3077102367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
G3244OtherBC/BS
FL305596500Medicaid
G3244OtherBC/BS