Healthcare Provider Details

I. General information

NPI: 1194799098
Provider Name (Legal Business Name): PAUL R. RUSSO ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 7TH ST S STE 450
ST PETERSBURG FL
33701-4741
US

IV. Provider business mailing address

603 7TH ST S
ST PETERSBURG FL
33701-4719
US

V. Phone/Fax

Practice location:
  • Phone: 727-527-5272
  • Fax: 727-522-7412
Mailing address:
  • Phone: 727-553-7431
  • Fax: 727-553-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN1955242
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberAPRN1955242
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPRN1955242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: