Provider Demographics
NPI:1710435128
Name:RUSSELL, KEARSTIN K (APRN)
Entity Type:Individual
Prefix:MS
First Name:KEARSTIN
Middle Name:K
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 1:100 W GORE ST STE 405
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1049
Mailing Address - Country:US
Mailing Address - Phone:321-841-9340
Mailing Address - Fax:321-841-9344
Practice Address - Street 1:100 W GORE ST STE 405
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1049
Practice Address - Country:US
Practice Address - Phone:321-841-9340
Practice Address - Fax:321-841-9344
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131675363LF0000X
FL9309748363LF0000X
FLAPRN9309748363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily