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NPI Code Detail

MEDICARE: BILLIE J RUSSELL ARNP

MEDICARE:   BILLIE J RUSSELL  ARNP
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
1363LA2200XAdult Health Nurse Practitioner315762FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1315762OTHERFLARNP LICENSE

General Provider Information

NPI Number : 1871640250
Entity Type Code : Individual
Provider Name (Legal Business Name) : BILLIE J RUSSELL ARNP
Provider Business Mailing Address
First Line : 756 COUNTY ROAD 13 SOUTH
Second Line :
City : ST. AUGUSTINE
State : FL
Zip : 32092
Country : US
Telephone Number : 904-501-1903
Fax Number :
Provider Business Practice Location Address
First Line : 4348 SOUTHPOINT BLVD STE 100
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-0903
Country : US
Telephone Number : 248-434-6169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 10/09/2023

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