Healthcare Provider Details

I. General information

NPI: 1134052848
Provider Name (Legal Business Name): NATALIE ELAINE RUSSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 N STATE ROAD 7 STE 20
COCONUT CREEK FL
33073-4379
US

IV. Provider business mailing address

1751 NW 94TH AVE
CORAL SPRINGS FL
33071-6080
US

V. Phone/Fax

Practice location:
  • Phone: 954-228-5616
  • Fax:
Mailing address:
  • Phone: 407-417-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-541915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: