Individual
MARISA C RANDAZZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 662-4000
Mailing address
2113 CARPENTER ST APT A, PHILADELPHIA, PA 19146-2526
(856) 220-5012
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
SP031541
PA
363LP2300X
Primary Care Nurse Practitioner
Primary
SP031541
PA
Other
Enumeration date
04/01/2025
Last updated
04/01/2025
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