Healthcare Provider Details

I. General information

NPI: 1285176289
Provider Name (Legal Business Name): JARED STEVEN BUTT R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16161 CALDERA LN
NAPLES FL
34110-2831
US

IV. Provider business mailing address

16161 CALDERA LN
NAPLES FL
34110-2831
US

V. Phone/Fax

Practice location:
  • Phone: 208-716-1422
  • Fax:
Mailing address:
  • Phone: 208-716-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9379637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: