Individual
RUSSELL DAN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
4428 SW 105TH DR, GAINESVILLE, FL 32608-7139
(941) 735-1790
Mailing address
4428 SW 105TH DR, GAINESVILLE, FL 32608-7139
(941) 735-1790
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
9433286
FL
Other
Enumeration date
09/10/2020
Last updated
09/10/2020
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