Provider Demographics
NPI:1447623004
Name:TUTHILL, ADDY MAURO (PA)
Entity type:Individual
Prefix:
First Name:ADDY
Middle Name:MAURO
Last Name:TUTHILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S OCEAN BLVD
Mailing Address - Street 2:APT 2R
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-8010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 N FEDERAL HWY
Practice Address - Street 2:SUITE 305
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33306-1060
Practice Address - Country:US
Practice Address - Phone:561-507-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant