Provider Demographics
NPI:1063732212
Name:BUTLER, JEANNETTE
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:BUTLER
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:PO BOX 7146
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33673-7146
Mailing Address - Country:US
Mailing Address - Phone:813-610-2718
Mailing Address - Fax:
Practice Address - Street 1:3603 TEMPLE ST
Practice Address - Street 2:APT.B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-1509
Practice Address - Country:US
Practice Address - Phone:813-610-2718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker