Provider Demographics
NPI:1053493593
Name:BUTTERBAUGH, PATRICIA J (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:J
Last Name:BUTTERBAUGH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:JEAN
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1725 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2911
Mailing Address - Country:US
Mailing Address - Phone:321-843-9017
Mailing Address - Fax:321-843-9019
Practice Address - Street 1:1725 COOK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2911
Practice Address - Country:US
Practice Address - Phone:321-843-9017
Practice Address - Fax:321-843-9019
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9187794363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32106OtherBCBS
FL5752463OtherAETNA
FL000902300Medicaid
FLARNP9187794OtherMEDICAL LICENSE
FL000902300Medicaid
FLU0023YMedicare PIN