Provider Demographics
NPI:1760297386
Name:GUTSCH, MARY (PA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GUTSCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:10501 FGCU BLVD S
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33965-6502
Mailing Address - Country:US
Mailing Address - Phone:740-339-9196
Mailing Address - Fax:
Practice Address - Street 1:909 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1251
Practice Address - Country:US
Practice Address - Phone:139-789-7008
Practice Address - Fax:813-558-6185
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9119768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant