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General NPI Number Information
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NPI Number | 1417596883
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Entity Type | Individual
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Provider Name | LYNNE MARIE BUSTRAAN APRN
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Gender | Female
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Dates
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Enumeration Date | 01/02/2020
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 52 W UNDERWOOD ST
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City | ORLANDO
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State | FL
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Zip | 32806-1110
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Country | US
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Telephone | 407-843-7165
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 N PENINSULA AVE APT 425
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-2079
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Country | US
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Telephone | 407-221-4914
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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 | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | APRN2689732
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License Number State | FL
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