Individual
JON MICHAEL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5123 4TH AVENUE CIR E, BRADENTON, FL 34208-5620
(941) 744-5510
Mailing address
5123 4TH AVENUE CIR E, BRADENTON, FL 34208-5620
(941) 744-5510
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
9457376
FL
363L00000X
Nurse Practitioner
Primary
11026893
FL
Other
Enumeration date
05/01/2023
Last updated
07/05/2023
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