Provider Demographics
NPI:1851382725
Name:BUTHMAN, NANCY (ARNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BUTHMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-278-3857
Practice Address - Street 1:3511 DR. MARTIN LUTHER KING JR BLVD.
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-3157
Practice Address - Country:US
Practice Address - Phone:239-332-0954
Practice Address - Fax:239-332-0941
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1907832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301852100Medicaid
FLS36553Medicare UPIN
FL301852100Medicaid