Provider Demographics
NPI:1922366533
Name:RUSSELL, RACHEL (NP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 CIMARRON TER
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-4922
Mailing Address - Country:US
Mailing Address - Phone:727-460-5899
Mailing Address - Fax:855-596-4306
Practice Address - Street 1:2151 CIMARRON TER
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-4922
Practice Address - Country:US
Practice Address - Phone:727-460-5899
Practice Address - Fax:855-596-4306
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9282754363LW0102X, 363LA2200X
GA208711363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013608100Medicaid
FLIA174ZMedicare PIN