RANDOLPH DIABETES AND WELLNESS LLC NPI 1609378991

NPI Information

RANDOLPH DIABETES AND WELLNESS LLC is an adult medicine family medicine in Tampa, FL. The provider is the National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code. RANDOLPH DIABETES AND WELLNESS LLC NPI is 1609378991. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

13047 W LINEBAUGH AVE STE 102
TAMPA, FL
ZIP 33626-487
Phone: (813) 475-6542
Fax: (813) 475-6874

The provider's authorized official is Kimberly T Randolph .
The authorized official title is Owner/manager and has the following contact phone number (813) 846-7698.

The CLIA number assigned to this NPI record is 10D2182314 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/2/2018 and was last updated on 5/12/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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