Provider Demographics
NPI:1285115303
Name:SUTTLES, ZAKARY JOSEPH (LPN)
Entity type:Individual
Prefix:
First Name:ZAKARY
Middle Name:JOSEPH
Last Name:SUTTLES
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TANGLEWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4433
Mailing Address - Country:US
Mailing Address - Phone:904-652-8318
Mailing Address - Fax:
Practice Address - Street 1:3508 FAR WEST BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3080
Practice Address - Country:US
Practice Address - Phone:781-486-4109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5236647164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse