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General NPI Number Information
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NPI Number | 1801551098
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Entity Type | Individual
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Provider Name | AMANDA KATHLEEN RUSS DNP, APRN
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Gender | Female
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 1400 N US HIGHWAY 441 STE 942
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City | THE VILLAGES
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State | FL
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Zip | 32159-6813
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Country | US
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Telephone | 352-751-4958
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Fax |
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Provider Business Mailing Address
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Address Line | 2125 AITKIN LOOP
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City | LEESBURG
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State | FL
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Zip | 34748-2955
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Country | US
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Telephone | 435-590-3818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN11014385
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License Number State | FL
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