Provider Demographics
NPI:1407212467
Name:TUTLEWSKI, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TUTLEWSKI
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 1:811 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-7156
Mailing Address - Country:US
Mailing Address - Phone:219-776-5010
Mailing Address - Fax:
Practice Address - Street 1:5800 OVERSEAS HWY
Practice Address - Street 2:#38
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2735
Practice Address - Country:US
Practice Address - Phone:305-743-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL9392197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program