RANDOLPH DIABETES AND WELLNESS LLC


Address: 8017 Savannah Sunset Ln, Tampa, FL 33615-1388
Phone: 8138467698

RANDOLPH DIABETES AND WELLNESS LLC (NPI# 1609378991) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1609378991
Entity Type Organization
Organization Name RANDOLPH DIABETES AND WELLNESS LLC
Practice Address 8017 Savannah Sunset Ln
Tampa
FL 33615-1388
Practice Telephone 8138467698
Enumeration Date 2018-03-02
Last Update Date 2019-08-20
Authorized Official Name MS. KIMBERLY T RANDOLPH (OWNER/MANAGER)
Authorized Official Telephone 8138467698
Authorized Official Credential ARNP-C
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363LA2200X Nurse Practitioner
Specialization: Adult Health
ARNP9318390 FL Physician Assistants & Advanced Practice Nursing Providers
Y 261QH0100X Clinic/Center
Specialization: Health Service
Ambulatory Health Care Facilities

Office Location

Street Address 8017 SAVANNAH SUNSET LN
City TAMPA
State FL
Zip Code 33615-1388

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Taxonomy Information

Taxonomy Code 261QH0100X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Health Service

Taxonomy Definition

Definition to come...
Notes: [7/1/2006: modified title]

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Competitor

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City TAMPA
Zip Code 33615

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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