Provider Demographics
NPI:1376200691
Name:SHUTTER, PAUL AUSTIN (APRN)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:AUSTIN
Last Name:SHUTTER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 EICHENFELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5908
Mailing Address - Country:US
Mailing Address - Phone:813-684-6000
Mailing Address - Fax:813-654-9032
Practice Address - Street 1:635 EICHENFELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5908
Practice Address - Country:US
Practice Address - Phone:813-684-6000
Practice Address - Fax:813-654-9032
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015180363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner