Healthcare Provider Details

I. General information

NPI: 1790389914
Provider Name (Legal Business Name): RANDALL JAMES SCHRENK DNP, APRN, CPNP-AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2020
Last Update Date: 11/29/2020
Certification Date: 11/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

5655 OAK HOLLOW LN
OVIEDO FL
32765-8737
US

V. Phone/Fax

Practice location:
  • Phone: 727-898-7451
  • Fax:
Mailing address:
  • Phone: 417-771-0455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number11008840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: