Provider Demographics
NPI:1295189447
Name:KAUTZ, SCOTT JEFFREY JR (ARNP-BC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JEFFREY
Last Name:KAUTZ
Suffix:JR
Gender:M
Credentials:ARNP-BC
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1324 LAKELAND HILLS BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-5742
Mailing Address - Country:US
Mailing Address - Phone:863-687-1100
Mailing Address - Fax:863-630-6528
Practice Address - Street 1:4715 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2101
Practice Address - Country:US
Practice Address - Phone:632-846-8008
Practice Address - Fax:863-413-5807
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9349673363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9349673OtherSTATE LICENSE
FL018165300Medicaid
FLIQ740ZMedicare PIN