Most Relevant Information
Provider Data
| NPI Number: | 1003069022 |
| Provider Name: | RANDI MARIE BUSTIN PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | PA9104629 |
Most Important Dates
| Enumeration Date: | 11/04/2008 |
| Last Updated: | 10/28/2011 |
Provider Practice Location
1502 E FOWLER AVE
TAMPA
FL
336125416
Practice Location Phone/Fax
| Phone: | 8138660950 |
| Fax: | 8138660929 |
Provider Mailing Location
PO BOX 82969
TAMPA
FL
336822969
Provider Mailing Phone/Fax
| Phone: | 8138660930 |
| Fax: | 8138660929 |