Provider Demographics
NPI:1528658945
Name:RUSSELL, TERESA DAWN (APRN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:DAWN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0967
Mailing Address - Country:US
Mailing Address - Phone:352-354-9000
Mailing Address - Fax:352-620-0255
Practice Address - Street 1:125 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0967
Practice Address - Country:US
Practice Address - Phone:352-354-9000
Practice Address - Fax:352-620-0255
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010455363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner