Provider Demographics
NPI:1467891820
Name:BUTSCHEK, STACY MICHELLE
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MICHELLE
Last Name:BUTSCHEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 FOXFORREST CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2335
Mailing Address - Country:US
Mailing Address - Phone:407-948-2614
Mailing Address - Fax:
Practice Address - Street 1:235 E PRINCETON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5553
Practice Address - Country:US
Practice Address - Phone:407-948-2614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9212726367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife