# JON MICHAEL RUSSELL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1942998513
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WC0200X | Critical Care Medicine Registered Nurse | 9457376 | FL | — |
| 363L00000X | Nurse Practitioner | 11026893 | FL | Yes |

## Other

- **Enumeration date:** 05/01/2023
- **Last updated:** 07/05/2023