Individual provider Active NPI

Alyssa Breanna Butterbaugh, APRN

  • Acute Care Nurse Practitioner
  • Port Charlotte, FL
National Provider Identifier
1902616923
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
11037083 Issued in FL
Practice address
21202 Olean Blvd Ste C6
Port Charlotte, FL 33952-6771
Phone
(585) 519-9998
NPI assigned
Jan 11, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 11037083 FL Primary

Addresses

Primary practice location

21202 Olean Blvd Ste C6
Port Charlotte, FL 33952-6771

Mailing address

2139 NW 19TH Ave
Cape Coral, FL 33993-3862
Phone (585) 519-9998

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250717001747 FL Practitioner - Nurse Practitioner 3779098744 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Harbor Medical Group LLCGroup PAC ID 5092078881, 9 clinicians
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians
Cape Coral Hospitalists IncGroup PAC ID 2961504923, 27 clinicians

Practice addresses (Care Compare)

21202 Olean Blvd
Suite C6
Port Charlotte, FL 33952-6771
Phone (941) 889-7440

2343 Aaron St
Port Charlotte, FL 33952-5305
Phone (941) 629-2900

636 Del Prado Blvd S
Cape Coral, FL 33990-2668
Phone (239) 574-2323

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11037083FLMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC CurrentSince Dec 1, 2025 Accepting new patients
Harbor Medical Group LLC CurrentSince Jul 1, 2025 Accepting new patients
Millennium Physician Group LLC CurrentSince Dec 1, 2025 Accepting new patients

Locations

636 Del Prado Blvd S
Cape Coral, FL 33990
Phone (239) 332-5344

3434 Hancock Bridge Pkwy
Ste 301
North Ft Myers, FL 33903
Phone 877856377411108

2500 Harbor Blvd
Pt Charlotte, FL 33952
Phone (941) 766-4122

2343 Aaron St
Pt Charlotte, FL 33952
Phone (855) 979-5700

21202 Olean Blvd
Ste C6
Pt Charlotte, FL 33952
Phone (941) 889-7440

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: alyssa.butterbaugh.1@4290.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775433600000",
    "number": "1902616923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2139 NW 19TH AVE",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339933862",
            "telephone_number": "585-519-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21202 OLEAN BLVD STE C6",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526771",
            "telephone_number": "585-519-9998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTTERBAUGH",
        "first_name": "ALYSSA",
        "middle_name": "BREANNA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-11",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "11037083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.