Provider Demographics
NPI:1629005087
Name:TUTIVEN, JACQUELINE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:L
Last Name:TUTIVEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-851-4405
Practice Address - Street 1:AMERICAN ANESTHESIOLOGY OF FLORIDA, INC.
Practice Address - Street 2:5352 LINTON BLVD
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6514
Practice Address - Country:US
Practice Address - Phone:561-498-1754
Practice Address - Fax:561-327-2674
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78620207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2574331-00Medicaid
FL49262Medicare ID - Type Unspecified
FL2574331-00Medicaid