Healthcare Provider Details

I. General information

NPI: 1497667133
Provider Name (Legal Business Name): DAWN LENAE RUSZKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N LAKE DESTINY RD STE 450
MAITLAND FL
32751-4886
US

IV. Provider business mailing address

14222 CONIFER DR
ORLANDO FL
32832-6521
US

V. Phone/Fax

Practice location:
  • Phone: 407-567-2830
  • Fax:
Mailing address:
  • Phone: 407-567-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberRN2005052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: