Provider Demographics
NPI:1093585754
Name:BUTLER, EVELYN DIAZ (PMHNP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:DIAZ
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:DIAZ
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:23319 NW COUNTY ROAD 1493
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-4188
Mailing Address - Country:US
Mailing Address - Phone:904-226-4124
Mailing Address - Fax:
Practice Address - Street 1:619 S MARION AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL669707363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty