Individual
PHYLLIS JUNE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, ARNP, GCNS-BC
Contact information
Practice address
3368 WOODS EDGE CIR, SUITE 104, BONITA SPRINGS, FL 34134-3437
(239) 495-5315
(239) 596-1709
Mailing address
2675 CREEK LN, # 202, NAPLES, FL 34119-7992
(239) 860-7587
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
ARNP 2128402
FL
364SG0600X
Gerontology Clinical Nurse Specialist
0134457-18
CT
Other
Enumeration date
07/16/2005
Last updated
12/09/2009
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