Healthcare Provider Details

I. General information

NPI: 1528658945
Provider Name (Legal Business Name): TERESA DAWN RUSSELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SW 11TH ST
OCALA FL
34471-0967
US

IV. Provider business mailing address

125 SW 11TH ST
OCALA FL
34471-0967
US

V. Phone/Fax

Practice location:
  • Phone: 352-354-9000
  • Fax: 352-620-0255
Mailing address:
  • Phone: 352-354-9000
  • Fax: 352-620-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11010455
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: