Provider Demographics
NPI:1710544911
Name:BUTLER, EVANGELINE DIAZ (APRN FNP BC)
Entity type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:DIAZ
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APRN FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 WELLSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-4111
Mailing Address - Country:US
Mailing Address - Phone:386-627-4553
Mailing Address - Fax:
Practice Address - Street 1:21 OLD KINGS RD N UNIT 108
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8254
Practice Address - Country:US
Practice Address - Phone:386-627-4553
Practice Address - Fax:386-232-5152
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9320265163WC0200X
FL11009579363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine