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1730927989 NPI number — RETINA LYNN RUSSELL

NPI Number: 1730927989
Health Care Provider/Practitioner: RETINA LYNN RUSSELL

Information about “1730927989” NPI (RETINA LYNN RUSSELL) exists in 1730927989 in HTML format HTML  |  1730927989 in plain Text format TXT  |  1730927989 in PDF (Portable Document Format) PDF  |  1730927989 in an XML format XML  formats.

NPI Number : 1730927989 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730927989",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RUSSELL",
    "FirstName": "RETINA LYNN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3200 HIAWASEE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ORLANDO",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32835",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "407-286-4031",
    "MailingAddressFaxNumber": "888-588-2752",
    "FirstLinePracticeLocationAddress": "6250 HAZELTINE NATIONAL DR STE 106",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ORLANDO",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32822-5102",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "855-295-3276",
    "PracticeLocationAddressFaxNumber": "888-588-2752",
    "EnumerationDate": "07/19/2024",
    "LastUpdateDate": "03/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "106S00000X",
          "TaxonomyName": "Behavior Technician",
          "LicenseNumber": "1730927989",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106S00000X",
          "TaxonomyName": "Behavior Technician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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