Provider Demographics
NPI:1881068781
Name:LUTTRELL, MICHAEL (APRN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LUTTRELL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13837 CIRCA CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4382
Mailing Address - Country:US
Mailing Address - Phone:813-684-2663
Mailing Address - Fax:813-658-6222
Practice Address - Street 1:13837 CIRCA CROSSING DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4382
Practice Address - Country:US
Practice Address - Phone:813-684-2663
Practice Address - Fax:813-658-6222
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2017363LF0000X
FLAPRN11019194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily