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NPI Code Detail

MEDICARE: MR. RAYMOND CARL TRUSSELL JR. CRNA

MEDICARE: MR. RAYMOND CARL TRUSSELL JR. CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistAPRN11040823FL

General Provider Information

NPI Number : 1083297261
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RAYMOND CARL TRUSSELL JR. CRNA
Provider Business Mailing Address
First Line : 26643 DEAN CT S
Second Line :
City : DAPHNE
State : AL
Zip : 36526-8906
Country : US
Telephone Number : 334-740-1683
Fax Number :
Provider Business Practice Location Address
First Line : 421 N 21ST AVE
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33020-4013
Country : US
Telephone Number : 305-899-4722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2021
Last Update Date : 12/23/2025

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