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NPI Code Detail

MEDICARE: SARAH ELIZABETH MUNDY-RUSSELL MSN, APRN, PMHNP-BC

MEDICARE: SARAH ELIZABETH MUNDY-RUSSELL MSN, APRN, PMHNP-BC
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
1163W00000XRegistered NurseRN9451099FL
2363LP0808XPsychiatric/Mental Health Nurse Practitioner11022007FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902447972
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH ELIZABETH MUNDY-RUSSELL MSN, APRN, PMHNP-BC
Provider Business Mailing Address
First Line : 208 BOOTH RD STE D
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-5718
Country : US
Telephone Number : 386-235-9585
Fax Number : 407-326-2496
Provider Business Practice Location Address
First Line : 245 WOODSTOCK CT
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-4863
Country : US
Telephone Number : 386-235-9585
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2019
Last Update Date : 02/14/2023

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