Individual provider Active NPI

Ann Marie Bustamante, FNP-C

  • Family Nurse Practitioner
  • Lehigh Acres, FL
National Provider Identifier
1013424779
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9202661 Issued in FL
Practice address
1350 Lee Blvd
Lehigh Acres, FL 33936-4846
Phone
(866) 389-2727
NPI assigned
Jan 3, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 9202661 FL Primary

Addresses

Primary practice location

1350 Lee Blvd
Lehigh Acres, FL 33936-4846

Mailing address

1 CVS Dr
Woonsocket, RI 02895-6146

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180514001460 FL Practitioner - Nurse Practitioner 8123382462 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minuteclinic LLCGroup PAC ID 6709850241, 576 clinicians

Practice addresses (Care Compare)

12280 Lake Underhill Rd
Orlando, FL 32825-5009
Phone (866) 389-2727

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9202661FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic LLC Family CurrentSince Apr 6, 2018 Accepting new patients
Primary Care PLLC Family CurrentSince Nov 5, 2024 Accepting new patients

Locations

7575 Osceola Polk Line Rd
Davenport, FL 33896
Phone (321) 677-0531

1350 Lee Blvd
Lehigh Acres, FL 33936
Phone (239) 369-2163

121 W Macclenny Ave
Macclenny, FL 32063
Phone (904) 259-6380

8740 SW 40th St
Miami, FL 33165
Phone (305) 221-8337

12401 Miramar Pkwy
Miramar, FL 33027
Phone (954) 538-8473

12280 Lake Underhill Rd
Orlando, FL 32825
Phone (407) 273-3284

8765 S Dixie Hwy
Pinecrest, FL 33156
Phone (305) 740-6840

1501 S Federal Hwy
Pompano Beach, FL 33062
Phone (954) 788-0739

7599 W Sand Lake Rd
Sand Lake, FL 32819
Phone (407) 352-0943

1 Cvs Dr
Woonsocket, RI 02895
Phone (401) 770-1669

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1013424779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 LEE BLVD",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339364846",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "ANN MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-03",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9202661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lehigh Acres, FL

Sources for this page

Verify at the official NPI Registry.