Individual
MRS. AMY FAITH RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1908 BOOTHE CIR, LONGWOOD, FL 32750-6774
(407) 331-7007
Mailing address
903 PONDVIEW LN, CELEBRATION, FL 34747-4214
(321) 939-0871
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9100889
FL
Other
Enumeration date
11/13/2006
Last updated
07/08/2007
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