MEDICARE: MRS. SHELLY ANNE BUSCH

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	ARNP9266015	FL

General Provider Information

NPI Number	:	1427355742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELLY ANNE BUSCH

Provider Business Mailing Address
First Line	:	106 MEDICAL CENTER DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4907
Country	:	US
Telephone Number	:	850-769-0329
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 MEDICAL CENTER DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4907
Country	:	US
Telephone Number	:	850-769-0329
Fax Number	:

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

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/13/2019

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Directions to “ MRS. SHELLY ANNE BUSCH ” Practice Location

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