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NPI Code Detail

MEDICARE: MR. JACOB DAVID RANDOLPH DNP, RN

MEDICARE: MR. JACOB DAVID RANDOLPH DNP, RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistAPRN.CRNA.0021559OH

General Provider Information

NPI Number : 1982540027
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACOB DAVID RANDOLPH DNP, RN
Provider Business Mailing Address
First Line : 2142 N COVE BLVD
Second Line :
City : TOLEDO
State : OH
Zip : 43606-3895
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2142 N COVE BLVD
Second Line :
City : TOLEDO
State : OH
Zip : 43606-3895
Country : US
Telephone Number : 419-291-4491
Fax Number : 419-479-6030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2026
Last Update Date : 06/26/2026

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