Healthcare Provider Details

I. General information

NPI: 1437158227
Provider Name (Legal Business Name): RUSSELL F. AQUINO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 COLUMBIA ST STE 400
ORLANDO FL
32806-1115
US

IV. Provider business mailing address

60 COLUMBIA ST STE 400
ORLANDO FL
32806-1115
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-5851
  • Fax: 321-843-7381
Mailing address:
  • Phone: 321-843-5851
  • Fax: 321-843-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102289
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9102289
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9102289
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: