Healthcare Provider Details

I. General information

NPI: 1598118317
Provider Name (Legal Business Name): RANDALL ARMSTRONG VEREB ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RANDALL ARMSTRONG WILKERSON ATC, LAT

II. Dates (important events)

Enumeration Date: 07/16/2016
Last Update Date: 07/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 GALE LEMERAND DR
GAINESVILLE FL
32611-2051
US

IV. Provider business mailing address

PO BOX 14485
GAINESVILLE FL
32604-2485
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-4683
  • Fax: 352-375-8432
Mailing address:
  • Phone: 352-375-4683
  • Fax: 352-375-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL2563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: