Individual
MR. JOSEPH ERNEST RUSSAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3949 EVANS AVE, SUITE 102, FORT MYERS, FL 33901-9335
(239) 939-2622
(239) 939-0151
Mailing address
3949 EVANS AVE, SUITE 102, FORT MYERS, FL 33901-9335
(239) 939-2622
(239) 939-0151
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN9170581
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307512500
—
FL
01
—
G3940
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/16/2006
Last updated
03/20/2023
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