MEDICARE: CHELSEA L BUSTAMANTE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9330519	FL

General Provider Information

NPI Number	:	1144718503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA L BUSTAMANTE APRN

Provider Business Mailing Address
First Line	:	5116 TEMPIC DR
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-8033
Country	:	US
Telephone Number	:	352-551-6209
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 BAY RD
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2105
Country	:	US
Telephone Number	:	352-483-5633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	12/23/2022

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