# RANDOLPH DIABETES AND WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609378991
- **Authorized official:** MS. KIMBERLY T RANDOLPH APRN-C (OWNER/MANAGER)
- **Authorized official phone:** (813) 846-7698

## Contact information

- **Practice address:** 13047 W LINEBAUGH AVE STE 102, TAMPA, FL 33626-4487
- **Practice address phone:** (813) 475-6542
- **Practice address fax:** (813) 475-6874
- **Mailing address:** 13047 W LINEBAUGH AVE STE 102, TAMPA, FL 33626-4487
- **Mailing address phone:** (813) 475-6542
- **Mailing address fax:** (813) 475-6874

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | ARNP9318390 | FL | — |

## Other

- **Enumeration date:** 03/02/2018
- **Last updated:** 05/12/2021