Provider Demographics
NPI:1285373191
Name:RUSSELL, DELANEY ANN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:DELANEY
Middle Name:ANN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5110 S MANHATTAN AVE UNIT 6301
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-3462
Mailing Address - Country:US
Mailing Address - Phone:860-877-9470
Mailing Address - Fax:
Practice Address - Street 1:2502 W SAINT ISABEL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6318
Practice Address - Country:US
Practice Address - Phone:813-874-5707
Practice Address - Fax:813-874-5908
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9115943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant