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Individual

JOHN RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ARNP

Contact information

Practice address
12470 TELECOM DR STE 300W, TEMPLE TERRACE, FL 33637-0904
(813) 871-8200
(813) 357-5501
Mailing address
12470 TELECOM DR STE 300W, TEMPLE TERRACE, FL 33637-0904
(813) 871-8200
(813) 357-5501

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN1818802
FL
363L00000X
Nurse Practitioner
Primary
ARNP1818802
FL

Other

Enumeration date
02/06/2008
Last updated
10/08/2019
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