Provider Demographics
NPI:1932905577
Name:LUTZ, ATHINA MARIE (PMHNP)
Entity type:Individual
Prefix:MISS
First Name:ATHINA
Middle Name:MARIE
Last Name:LUTZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 POWELL RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-4230
Mailing Address - Country:US
Mailing Address - Phone:352-286-5456
Mailing Address - Fax:
Practice Address - Street 1:7330 POWELL RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-4230
Practice Address - Country:US
Practice Address - Phone:352-286-5456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9570988163WP0808X
FLAPRN11038811363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health