Provider Demographics
NPI:1528621265
Name:SHUTT, TARA (APN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SHUTT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:KUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1000 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-2116
Mailing Address - Country:US
Mailing Address - Phone:217-762-6241
Mailing Address - Fax:217-762-1702
Practice Address - Street 1:100 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:ATWOOD
Practice Address - State:IL
Practice Address - Zip Code:61913-7233
Practice Address - Country:US
Practice Address - Phone:217-578-3814
Practice Address - Fax:217-578-3100
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019113363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner