Provider Demographics
NPI:1164982914
Name:BUTLER, EDITHA ANNE (APRN)
Entity type:Individual
Prefix:MRS
First Name:EDITHA
Middle Name:ANNE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3440 MARINATOWN LN STE 210
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7049
Mailing Address - Country:US
Mailing Address - Phone:239-230-2000
Mailing Address - Fax:239-235-4640
Practice Address - Street 1:3440 MARINATOWN LN STE 210
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7049
Practice Address - Country:US
Practice Address - Phone:239-230-2000
Practice Address - Fax:239-235-4640
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22691363L00000X, 363LA2200X, 363LP0808X
FL11020436363LA2200X, 363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health