Provider Demographics
NPI:1790145761
Name:TUTRA, BESA (APN)
Entity Type:Individual
Prefix:
First Name:BESA
Middle Name:
Last Name:TUTRA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 W JIMMIE LEEDS RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9426
Mailing Address - Country:US
Mailing Address - Phone:609-652-6094
Mailing Address - Fax:609-653-8764
Practice Address - Street 1:72 W JIMMIE LEEDS RD STE 1100
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9426
Practice Address - Country:US
Practice Address - Phone:609-652-6094
Practice Address - Fax:609-653-8764
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00623800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner