Provider Demographics
NPI:1760534580
Name:BUTLER, TINA DIANE (APN)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:DIANE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13519 LONGTREE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-1331
Mailing Address - Country:US
Mailing Address - Phone:501-228-8104
Mailing Address - Fax:
Practice Address - Street 1:3915 W 8TH ST
Practice Address - Street 2:SUITE 222
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2028
Practice Address - Country:US
Practice Address - Phone:501-280-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1855 ANP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health