MEDICARE: DR. AUDRA LEIGH BUSENLEHNER M.D.

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	207Q00000X	Family Medicine Physician	21947	AL

General Provider Information

NPI Number	:	1720051584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDRA LEIGH BUSENLEHNER M.D.

Provider Business Mailing Address
First Line	:	601 S HARBOUR ISLAND BLVD STE 200
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5925
Country	:	US
Telephone Number	:	813-444-5838
Fax Number	:

Provider Business Practice Location Address
First Line	:	3515 WATERMELON RD
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-5174
Country	:	US
Telephone Number	:	205-737-9024
Fax Number	:

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	05/30/2024

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