Provider Demographics
NPI:1083297261
Name:TRUSSELL, RAYMOND CARL JR (SRNA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:CARL
Last Name:TRUSSELL
Suffix:JR
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:921 S PARK RD APT 210
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8756
Mailing Address - Country:US
Mailing Address - Phone:334-740-1683
Mailing Address - Fax:
Practice Address - Street 1:421 N 21ST AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4013
Practice Address - Country:US
Practice Address - Phone:305-899-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9554242163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine