Healthcare Provider Details

I. General information

NPI: 1992354948
Provider Name (Legal Business Name): JOSEPH C RANDAZZO JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W DR MARTIN LUTHER KING JR BLVD STE 320
TAMPA FL
33607-6055
US

IV. Provider business mailing address

2727 W DR MARTIN LUTHER KING JR BLVD STE 320
TAMPA FL
33607-6055
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-6748
  • Fax: 813-875-0359
Mailing address:
  • Phone: 813-877-6748
  • Fax: 813-875-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9112498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: