Provider Demographics
NPI:1902948466
Name:BUSTILLO-LEWIN, BARBARA C (PAC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:C
Last Name:BUSTILLO-LEWIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:C
Other - Last Name:BUSTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3434 HANCOCK BRIDGE PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7099
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:14350 METROPOLIS AVE STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4430
Practice Address - Country:US
Practice Address - Phone:239-275-3036
Practice Address - Fax:239-275-8480
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292731400Medicaid
FLAD440ZMedicare PIN