Provider Demographics
NPI:1508753880
Name:BUSHA, DEVIN ALLEN
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:ALLEN
Last Name:BUSHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 HEYBURN ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-8716
Mailing Address - Country:US
Mailing Address - Phone:786-481-8183
Mailing Address - Fax:
Practice Address - Street 1:3810 HEYBURN ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-8716
Practice Address - Country:US
Practice Address - Phone:786-481-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9497365163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine