Provider Demographics
NPI:1700052214
Name:SHUTT, JESSICA K (RNCS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:SHUTT
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 REBECCA LN STE 107
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8350
Mailing Address - Country:US
Mailing Address - Phone:386-775-0736
Mailing Address - Fax:386-775-0738
Practice Address - Street 1:2725 REBECCA LN STE 107
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8350
Practice Address - Country:US
Practice Address - Phone:386-775-0736
Practice Address - Fax:386-775-0738
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233581364SP0809X
FL9410846364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult