Provider Demographics
NPI:1073773545
Name:BUTLER, TANITA BREYANNEN DENAE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TANITA
Middle Name:BREYANNEN DENAE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MATLOCK RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3855
Mailing Address - Country:US
Mailing Address - Phone:817-453-0267
Mailing Address - Fax:
Practice Address - Street 1:2200 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3855
Practice Address - Country:US
Practice Address - Phone:817-453-0267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011803363LF0000X
TX1080257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily