Provider Demographics
NPI:1962840785
Name:BUSH, AMY SUE (ANP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:BUSH
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 MEASE DR STE 404
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6606
Mailing Address - Country:US
Mailing Address - Phone:727-712-0980
Mailing Address - Fax:813-635-2694
Practice Address - Street 1:1840 MEASE DR STE 404
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6606
Practice Address - Country:US
Practice Address - Phone:727-712-0980
Practice Address - Fax:813-635-2694
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28154057A163W00000X
IN71004528A363LA2200X
FLAPRN11025371363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201178780Medicaid
IN000000828521OtherANTHEM PROVIDER NUMBER
INP01342451Medicare PIN
IN201178780Medicaid