Individual
SHELLY RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1215 JACARANDA BLVD, VENICE, FL 34292-4520
(941) 451-8282
(877) 652-3059
Mailing address
1215 JACARANDA BLVD, VENICE, FL 34292-4520
(941) 451-8282
(877) 652-3059
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
11021994
FL
363LG0600X
Gerontology Nurse Practitioner
Primary
11021994
FL
Other
Enumeration date
09/23/2022
Last updated
09/23/2022
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