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General NPI Number Information
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NPI Number | 1538989264
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Entity Type | Individual
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Provider Name | JUSTIN BUTLER PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 1542 KINGSLEY AVE STE 136-137
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City | ORANGE PARK
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State | FL
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Zip | 32073-4586
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Country | US
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Telephone | 239-690-6906
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Fax |
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Provider Business Mailing Address
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Address Line | 4153 FISHING CREEK LN
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City | MIDDLEBURG
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State | FL
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Zip | 32068-3986
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Country | US
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Telephone | 904-210-4701
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11035870
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License Number State | FL
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