Individual
MRS. CAROL D RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
SPACE COAST VOLUNTEERS IN MEDICINE, 2555 JUDGE FRAN JAMIESON WAY, VIERA, FL 32940
(321) 639-5813
(321) 637-7312
Mailing address
2555 JUDGE FRAN JAMIESON WAY, VIERA, FL 32940-5998
(321) 639-5813
(321) 637-7312
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA2709
FL
363AM0700X
Medical Physician Assistant
Primary
LL861
FL
363AM0700X
Medical Physician Assistant
PA2709
FL
Other
Enumeration date
09/12/2005
Last updated
01/26/2024
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