MEDICARE: MR. BERNARDO C LOBUSTA JR. MSN, APRN, FNP-BC

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	363L00000X	Nurse Practitioner	11009381	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639786338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BERNARDO C LOBUSTA JR. MSN, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	11965 ELIZABETH ANN CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-0763
Country	:	US
Telephone Number	:	904-476-0812
Fax Number	:

Provider Business Practice Location Address
First Line	:	13500 SUTTON PARK DR S STE 504
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-5290
Country	:	US
Telephone Number	:	904-874-5775
Fax Number	:

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

Provider Enumeration Date	:	09/26/2020
Last Update Date	:	09/26/2020

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