Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | APRN9328420 | FL |
NPI | 1023782612 |
---|---|
Provider Name | Courtney Randall |
First Address | Tampa, FL 33626-5107 |
Second Address | Tampa, FL 33626-5107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2021 |
Last Update Date | 06/08/2021 |