Individual
ANGELA P RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1475 NW 12TH AVE, BOX 016960 M851, MIAMI, FL 33136-1002
(305) 243-7520
Mailing address
1475 NW 12TH AVE, BOX 016960 M851, MIAMI, FL 33136-1002
(305) 243-7520
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP1082342
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
1082342
FL
364SF0001X
Family Health Clinical Nurse Specialist
082342
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3050742-00
—
FL
Enumeration date
07/20/2006
Last updated
09/18/2014
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