Basic Information
| Provider Information | |||||||||
| NPI: | 1023080017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSTIN | ||||||||
| FirstName: | ROANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 SE 1ST AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344710478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526906300 | ||||||||
| FaxNumber: | 3526906802 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 SE 1ST AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344710478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526906300 | ||||||||
| FaxNumber: | 3526906802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 03/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | ARNP2078412 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 303100400 | 05 | FL | MEDICAID |