Healthcare Provider Details

I. General information

NPI: 1144832049
Provider Name (Legal Business Name): RUSSELL MWENGELEKAYI TSHIABA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TSHIABA MWENGELEKAYI RUSSELL LPN, RN

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 OCOEE APOPKA RD
APOPKA FL
32703
US

IV. Provider business mailing address

2100 OCOEE APOPKA RD
APOPKA FL
32703
US

V. Phone/Fax

Practice location:
  • Phone: 407-652-7026
  • Fax: 407-652-7027
Mailing address:
  • Phone: 407-652-7026
  • Fax: 407-652-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11008517
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: