Individual
DR. PEGGY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4509 NW 23RD AVE STE D, GAINESVILLE, FL 32606-6570
(772) 801-0802
Mailing address
3900 OAK HAMMOCK LN, FORT PIERCE, FL 34981-4521
(850) 212-4655
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY9008
FL
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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