Individual
LESLEY ANN RANDOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
391 N MAIN ST, KISSIMMEE, FL 34744-5271
(407) 518-1074
Mailing address
391 N MAIN ST, KISSIMMEE, FL 34744-5271
(407) 518-1074
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN11002450
FL
363LP2300X
Primary Care Nurse Practitioner
APRN11002450
FL
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
APRN11002450
FL
364SA2200X
Adult Health Clinical Nurse Specialist
2014003661
MO
364SG0600X
Gerontology Clinical Nurse Specialist
2014003661
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014003661
BOARD OF NURSING LICENSE
MO
01
—
APRN11002450
BOARD OF NURSING LICENSE
FL
Enumeration date
02/12/2014
Last updated
04/28/2021
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