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General NPI Number Information
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NPI Number | 1639786338
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Entity Type | Individual
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Provider Name | BERNARDO C LOBUSTA JR. MSN, APRN, FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/26/2020
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Last Update Date | 09/26/2020
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Provider Practice Location Address
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Address Line | 13500 SUTTON PARK DR S STE 504
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City | JACKSONVILLE
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State | FL
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Zip | 32224-5290
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Country | US
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Telephone | 904-874-5775
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Fax |
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Provider Business Mailing Address
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Address Line | 11965 ELIZABETH ANN CT
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City | JACKSONVILLE
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State | FL
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Zip | 32223-0763
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Country | US
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Telephone | 904-476-0812
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11009381
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License Number State | FL
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