Provider Demographics
NPI:1588741276
Name:SUTTON, ANN MARIE (LMT)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7518 SUWANEE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32409-1295
Mailing Address - Country:US
Mailing Address - Phone:850-596-6438
Mailing Address - Fax:
Practice Address - Street 1:1047 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3607
Practice Address - Country:US
Practice Address - Phone:850-596-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47840174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist