Healthcare Provider Details

I. General information

NPI: 1508053240
Provider Name (Legal Business Name): VALERIE MARIE RUSSELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 1ST ST
SAN FRANCISCO CA
94105-2687
US

IV. Provider business mailing address

36 OCHLOCKONEE ST
CRAWFORDVILLE FL
32327-2038
US

V. Phone/Fax

Practice location:
  • Phone: 888-803-3370
  • Fax: 888-803-3331
Mailing address:
  • Phone: 850-363-4935
  • Fax: 850-676-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3115262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: