Provider Demographics
NPI:1851882120
Name:CUTHBERTSON, LOTTIE (RN)
Entity Type:Individual
Prefix:
First Name:LOTTIE
Middle Name:
Last Name:CUTHBERTSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4534 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-2914
Mailing Address - Country:US
Mailing Address - Phone:727-804-3753
Mailing Address - Fax:
Practice Address - Street 1:4534 21ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-2914
Practice Address - Country:US
Practice Address - Phone:727-804-3753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2211472163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC316-524-66-674-1Medicaid
FL$$$$$$$$$Medicaid