Provider Demographics
NPI:1710330733
Name:BELL, IDA JUTTING (NP)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:JUTTING
Last Name:BELL
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 PALM DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6557
Mailing Address - Country:US
Mailing Address - Phone:386-316-8092
Mailing Address - Fax:
Practice Address - Street 1:1175 DUNLAWTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4741
Practice Address - Country:US
Practice Address - Phone:386-316-8092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND200493363L00000X
MT257346363L00000X
FL9257624363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner