Healthcare Provider Details

I. General information

NPI: 1144947284
Provider Name (Legal Business Name): RANDY ALEX EDWARDS CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2197
US

IV. Provider business mailing address

6263 NW SWEETWOOD DR
PORT ST LUCIE FL
34987-5856
US

V. Phone/Fax

Practice location:
  • Phone: 305-928-7249
  • Fax: 305-630-3632
Mailing address:
  • Phone: 305-928-7249
  • Fax: 305-630-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11033304
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11033304
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR257284
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: