Provider Demographics
NPI:1710970454
Name:JUTTE, MICHAEL (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:JUTTE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 N OLIVE AVE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3520
Mailing Address - Country:US
Mailing Address - Phone:561-655-4450
Mailing Address - Fax:561-655-4469
Practice Address - Street 1:1117 N OLIVE AVE
Practice Address - Street 2:SUITE #202
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3520
Practice Address - Country:US
Practice Address - Phone:561-655-4450
Practice Address - Fax:561-655-4469
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME2970352207K00000X
FLARNP 2970352363L00000X
NC5006793363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304488200Medicaid
FL304488200Medicaid
FL304488200Medicaid