Provider Demographics
NPI:1750314753
Name:NUSBAUM, LANA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:M
Last Name:NUSBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BROTHER GEENEN WAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7102
Mailing Address - Country:US
Mailing Address - Phone:941-556-3215
Mailing Address - Fax:941-955-8214
Practice Address - Street 1:1900 BROTHER GEENEN WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7102
Practice Address - Country:US
Practice Address - Phone:941-556-3215
Practice Address - Fax:941-955-8214
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLL634208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE188ZMedicare PIN
A73758Medicare UPIN