Healthcare Provider Details

I. General information

NPI: 1720051584
Provider Name (Legal Business Name): AUDRA LEIGH BUSENLEHNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 WATERMELON RD
NORTHPORT AL
35473-5174
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 205-737-9024
  • Fax:
Mailing address:
  • Phone: 813-444-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21947
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: