Individual provider · Type 1 NPI

Carol D. Russell, PA-C

Medical Physician Assistant · Viera, FL

NPI number 1336134865 Active

Practice location

Space Coast Volunteers In Medicine, 2555 Judge Fran Jamieson Way
Viera, FL 32940

Call (321) 639-5813 Map

Fax (321) 637-7312

Mailing address

2555 Judge Fran Jamieson Way
Viera, FL 32940-5998

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000XPA2709 (FL)
Medical Physician Assistant 363AM0700XPA2709 (FL)
Medical Physician Assistant Primary 363AM0700XLL861 (FL)

Medical Physician Assistant: Definition to come...

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About NPI 1336134865

Carol D. Russell, PA-C's National Provider Identifier is 1336134865, issued on Sep 12, 2005. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Viera, FL. The record was last updated on Jan 26, 2024.