Avera, Russell Scott

Avera, Russell Scott is an individual health care provider with primary practice located at 4800 Belfort Road , Jacksonville FL 32256. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Avera, Russell Scott can be contacted via phone (904) 265-4801.

Contact Information

Primary practice address
4800 Belfort Road Jacksonville FL 32256
Phone: (904) 265-4801
Fax: (904) 265-4811
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X ARNP2950242 Florida

Profile Details

NPI number 1730174814
LBN Legal business name Avera, Russell Scott
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 15th, 2005
Last updated Mar 10th, 2020 - about 5 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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Identifiers

StateTypeNumberIssuer
All States NPI 1730174814 NPPES
Florida MEDICAID 306420400
Florida MEDICAID 000932247E

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