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Organization
RANDOLPH DIABETES AND WELLNESS LLC
Active
Organization
RANDOLPH DIABETES AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY T RANDOLPH APRN-C (OWNER/MANAGER)
(813) 846-7698
Entity
Organization
Contact information
Practice address
13047 W LINEBAUGH AVE STE 102, TAMPA, FL 33626-4487
(813) 475-6542
(813) 475-6874
Mailing address
13047 W LINEBAUGH AVE STE 102, TAMPA, FL 33626-4487
(813) 475-6542
(813) 475-6874
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
NULL
363LA2200X
Adult Health Nurse Practitioner
ARNP9318390
FL
Other
Enumeration date
03/02/2018
Last updated
05/12/2021
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