Provider Demographics
NPI:1619175791
Name:BUSTOS, JESSICA T (ANP, RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:T
Last Name:BUSTOS
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Gender:F
Credentials:ANP, RN
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Mailing Address - Street 1:285 OLMSTED BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8731
Mailing Address - Country:US
Mailing Address - Phone:910-295-7246
Mailing Address - Fax:910-222-3168
Practice Address - Street 1:285 OLMSTED BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8731
Practice Address - Country:US
Practice Address - Phone:910-295-7246
Practice Address - Fax:910-222-3168
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2015-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY304681363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health