Provider Demographics
NPI:1508314279
Name:BUTLER, AMANDA E (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PIPER RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4150
Mailing Address - Country:US
Mailing Address - Phone:224-425-8683
Mailing Address - Fax:
Practice Address - Street 1:12900 CORTEZ BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6897
Practice Address - Country:US
Practice Address - Phone:352-596-1101
Practice Address - Fax:352-596-7869
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9491522363L00000X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209015071OtherSTATE LICENSURE
FLAPRN9491522OtherSTATE LICENSE