Healthcare Provider Details

I. General information

NPI: 1831184910
Provider Name (Legal Business Name): RANDALL HEARNE ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E ASH ST
PERRY FL
32347-2029
US

IV. Provider business mailing address

315 E ASH ST
PERRY FL
32347-2029
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-3278
  • Fax: 850-584-8171
Mailing address:
  • Phone: 850-584-3278
  • Fax: 850-584-6814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2961562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: