Healthcare Provider Details

I. General information

NPI: 1992062764
Provider Name (Legal Business Name): LYNDA J RUSINOWSKI ARNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 60TH CT
MIAMI FL
33155-4000
US

IV. Provider business mailing address

3200 SW 60TH CT
MIAMI FL
33155-4000
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-8401
  • Fax: 305-669-6574
Mailing address:
  • Phone: 305-663-8401
  • Fax: 305-669-6574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2123912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: