Provider Demographics
NPI:1588238711
Name:LUTEN, JAMISON (APRN, CWOCN, CSWD-C)
Entity Type:Individual
Prefix:
First Name:JAMISON
Middle Name:
Last Name:LUTEN
Suffix:
Gender:M
Credentials:APRN, CWOCN, CSWD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1916
Mailing Address - Country:US
Mailing Address - Phone:192-949-1770
Mailing Address - Fax:
Practice Address - Street 1:10150 HIGHLAND MANOR DR STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9712
Practice Address - Country:US
Practice Address - Phone:192-949-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019650363LF0000X
FLPMD525524163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty