Healthcare Provider Details

I. General information

NPI: 1497087241
Provider Name (Legal Business Name): TERRY L BOUTTY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 PALM SPRINGS DR STE 2A
ALTAMONTE SPRINGS FL
32701-7853
US

IV. Provider business mailing address

601 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-4802
US

V. Phone/Fax

Practice location:
  • Phone: 407-830-5577
  • Fax: 407-830-4164
Mailing address:
  • Phone: 407-303-2305
  • Fax: 866-445-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2743122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: