Active NPI
Amy Faith Russo, P.A.
- Medical Physician Assistant
- Longwood, FL
National Provider Identifier
1699846469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA9100889
- Practice address
- 1908 Boothe Cir
Longwood, FL 32750-6774 - Phone
- (407) 331-7007
- NPI assigned
- Nov 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA9100889 | FL | Primary |
Addresses
Primary practice location
1908 Boothe Cir
Longwood, FL 32750-6774
Mailing address
903 Pondview LN
Celebration, FL 34747-4214
Phone (321) 939-0871
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9100889 | FL | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699846469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "903 PONDVIEW LN",
"city": "CELEBRATION",
"state": "FL",
"postal_code": "347474214",
"telephone_number": "321-939-0871"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1908 BOOTHE CIR",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327506774",
"telephone_number": "407-331-7007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "AMY",
"middle_name": "FAITH",
"name_prefix": "Mrs.",
"credential": "P.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "PA9100889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longwood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.