Active NPI
Charles Tracy McCutcheon, APRN
- Family Nurse Practitioner
- Sunrise, FL
National Provider Identifier
1023652997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 11003236
- Practice address
- 13131 NW 11TH Dr
Sunrise, FL 33323-2953 - Phone
- (954) 695-5677
- NPI assigned
- Nov 4, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 11003236 | FL | Primary |
Addresses
Primary practice location
13131 NW 11TH Dr
Sunrise, FL 33323-2953
Mailing address
13131 NW 11TH Dr
Sunrise, FL 33323-2953
Phone (954) 695-5677
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11003236 | FL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572825600000",
"number": "1023652997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13131 NW 11TH DR",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333232953",
"telephone_number": "954-695-5677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13131 NW 11TH DR",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333232953",
"telephone_number": "954-695-5677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCUTCHEON",
"first_name": "CHARLES",
"middle_name": "TRACY",
"credential": "APRN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-11-04",
"last_updated": "2019-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "FL",
"license": "11003236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sunrise, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.