Healthcare Provider Details

I. General information

NPI: 1013738327
Provider Name (Legal Business Name): ALEXIS BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 AVALON PARK WEST BLVD STE 205
ORLANDO FL
32828-4809
US

IV. Provider business mailing address

420 E 2ND AVE
ROME GA
30161-3209
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11046145
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07241155
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: