Provider Demographics
NPI:1801619051
Name:CUTUK, ANISA (APRN)
Entity type:Individual
Prefix:
First Name:ANISA
Middle Name:
Last Name:CUTUK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10834 BIRCHARD LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6950
Mailing Address - Country:US
Mailing Address - Phone:404-503-5917
Mailing Address - Fax:
Practice Address - Street 1:905 PARK AVE STE 102
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4110
Practice Address - Country:US
Practice Address - Phone:904-736-2335
Practice Address - Fax:904-736-2336
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034184363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty