Individual
ANNALEE SANTOS RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
17820 SE 109TH AVE STE 108, SUMMERFIELD, FL 34491-8968
(352) 693-2340
(352) 693-2345
Mailing address
17820 SE 109TH AVE STE 108, SUMMERFIELD, FL 34491-8968
(352) 693-2340
(352) 693-2345
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9111964
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R200017915500
DRIVERS LICENSE
FL
Enumeration date
01/14/2019
Last updated
01/14/2019
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