Russell, Carol D

Russell, Carol D is an individual health care provider with primary practice located at Space Coast Volunteers In Medicine 2555 Judge Fran Jamieson Way, Viera FL 32940. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is her primary health care specialty. Russell, Carol D can be contacted via phone (321) 639-5813.

Contact Information

Primary practice address
Space Coast Volunteers In Medicine 2555 Judge Fran Jamieson Way Viera FL 32940
Phone: (321) 639-5813
Fax: (321) 637-7312
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA2709 Florida
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA2709 Florida
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X LL861 Florida

Profile Details

NPI number 1336134865
LBN Legal business name Russell, Carol D
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 12th, 2005
Last updated Jan 26th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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