Provider Demographics
NPI:1316796956
Name:BUTLER, CHINITA
Entity type:Individual
Prefix:MS
First Name:CHINITA
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 1:1505 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2219
Mailing Address - Country:US
Mailing Address - Phone:866-963-4333
Mailing Address - Fax:833-818-5050
Practice Address - Street 1:1505 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2219
Practice Address - Country:US
Practice Address - Phone:866-963-4333
Practice Address - Fax:833-818-5050
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2040-23246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy