Provider Demographics
NPI:1619730199
Name:LORUSSO, RONALD PATRICK II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:PATRICK
Last Name:LORUSSO
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 W AZEELE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3924
Mailing Address - Country:US
Mailing Address - Phone:321-951-8062
Mailing Address - Fax:
Practice Address - Street 1:3906 W AZEELE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3924
Practice Address - Country:US
Practice Address - Phone:321-951-8062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant