Provider Demographics
NPI:1649055542
Name:BLUE SKY MEDICAL LLC
Entity type:Organization
Organization Name:BLUE SKY MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDITHA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:803-260-2223
Mailing Address - Street 1:3440 MARINATOWN LN STE 210
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7049
Mailing Address - Country:US
Mailing Address - Phone:239-230-2000
Mailing Address - Fax:239-235-4640
Practice Address - Street 1:3440 MARINATOWN LN STE 210
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7049
Practice Address - Country:US
Practice Address - Phone:239-230-2000
Practice Address - Fax:239-235-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty