Provider Demographics
NPI:1215584180
Name:BUTLER, WENDY ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANNE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 GODDARD AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1139
Mailing Address - Country:US
Mailing Address - Phone:407-625-9782
Mailing Address - Fax:
Practice Address - Street 1:743 STRLING CTR PL
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5712
Practice Address - Country:US
Practice Address - Phone:407-647-1781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003767363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health