Provider Demographics
NPI:1285143131
Name:WITZEL, LINDSEY BUESCHER
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:BUESCHER
Last Name:WITZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 3RD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5788
Mailing Address - Country:US
Mailing Address - Phone:321-757-9711
Mailing Address - Fax:
Practice Address - Street 1:6420 3RD ST STE 104
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5788
Practice Address - Country:US
Practice Address - Phone:321-757-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9350234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily