Provider Demographics
NPI:1396133237
Name:RUSSINYOL, JORGE LUIS (ARNP,NP-C)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:RUSSINYOL
Suffix:
Gender:M
Credentials:ARNP,NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 NW 194TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6950
Mailing Address - Country:US
Mailing Address - Phone:305-301-7833
Mailing Address - Fax:
Practice Address - Street 1:8325 NW 194TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6950
Practice Address - Country:US
Practice Address - Phone:305-301-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9323928364SF0001X, 364SA2100X, 364SA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9323928OtherARNP