Healthcare Provider Details

I. General information

NPI: 1003658428
Provider Name (Legal Business Name): KEIRA RANDALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 4TH ST N # 28048
ST PETERSBURG FL
33702-4305
US

IV. Provider business mailing address

37689 LEAFSIDE LN
ZEPHYRHILLS FL
33541-3804
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-1339
  • Fax:
Mailing address:
  • Phone: 813-606-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11033257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: