Provider Demographics
NPI:1659648913
Name:YEUTTER, MICHAELLA M (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELLA
Middle Name:M
Last Name:YEUTTER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 866
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-0866
Mailing Address - Country:US
Mailing Address - Phone:321-725-8919
Mailing Address - Fax:321-725-8854
Practice Address - Street 1:1250 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3242
Practice Address - Country:US
Practice Address - Phone:321-725-8919
Practice Address - Fax:321-725-8854
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3252742163W00000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant