Provider Demographics
NPI:1467462143
Name:TUTT, ZANDRA (MD)
Entity Type:Individual
Prefix:
First Name:ZANDRA
Middle Name:
Last Name:TUTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZANDRA
Other - Middle Name:
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1835 E HALLANDALE BLVD
Mailing Address - Street 2:127
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:305-416-7149
Mailing Address - Fax:
Practice Address - Street 1:19351 LURIN AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-9608
Practice Address - Country:US
Practice Address - Phone:954-937-2944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062990207R00000X
CAA54432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372335600Medicaid
18620Medicare ID - Type Unspecified