Healthcare Provider Details

I. General information

NPI: 1508783523
Provider Name (Legal Business Name): JENNIFER J RANDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 DICK WILSON BLVD
TALLAHASSEE FL
32301-5137
US

IV. Provider business mailing address

3122 DICK WILSON BLVD
TALLAHASSEE FL
32301-5137
US

V. Phone/Fax

Practice location:
  • Phone: 850-671-1215
  • Fax:
Mailing address:
  • Phone: 850-671-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: