Provider Demographics
NPI:1194799098
Name:RUSSO, PAUL R (ARNP)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:R
Last Name:RUSSO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4719
Mailing Address - Country:US
Mailing Address - Phone:727-553-7431
Mailing Address - Fax:727-553-7432
Practice Address - Street 1:603 7TH ST S STE 450
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4741
Practice Address - Country:US
Practice Address - Phone:727-527-5272
Practice Address - Fax:727-522-7412
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1955242363LA2200X, 364SM0705X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108269700Medicaid