Provider Demographics
NPI:1992441521
Name:RUSSO, EMILY DAIL (APRN)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:DAIL
Last Name:RUSSO
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 1:6833 MEDICAL VIEW LN
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-6614
Mailing Address - Country:US
Mailing Address - Phone:813-780-6687
Mailing Address - Fax:
Practice Address - Street 1:6833 MEDICAL VIEW LN
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6614
Practice Address - Country:US
Practice Address - Phone:813-780-6687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily