Individual
MATTHEW RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
529 NW 60TH ST, GAINESVILLE, FL 32607-2008
(352) 331-5100
(352) 332-9607
Mailing address
1502 W NC HIGHWAY 54, STE 103, DURHAM, NC 27707-5572
(919) 354-0840
(919) 748-4441
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9315572
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
ARNP9315572
FL
Other
Enumeration date
08/31/2012
Last updated
10/16/2017
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