Healthcare Provider Details

I. General information

NPI: 1184605123
Provider Name (Legal Business Name): GERALD L BUTTELWERTH MS, ARNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 PALM DR
BELLEAIR BEACH FL
33786-3341
US

IV. Provider business mailing address

940 PALM DR
BELLEAIR BEACH FL
33786-3341
US

V. Phone/Fax

Practice location:
  • Phone: 727-596-4530
  • Fax:
Mailing address:
  • Phone: 727-596-4530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP 9198184
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN 063105 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: