Healthcare Provider Details

I. General information

NPI: 1255759759
Provider Name (Legal Business Name): ANYA RANDLE-COLCLOUGH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 W SUNRISE BLVD BLDG C
PLANTATION FL
33322-5426
US

IV. Provider business mailing address

8200 W SUNRISE BLVD BLDG C
PLANTATION FL
33322-5426
US

V. Phone/Fax

Practice location:
  • Phone: 954-370-8585
  • Fax: 954-370-1585
Mailing address:
  • Phone: 954-370-8585
  • Fax: 954-370-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9275132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: