Healthcare Provider Details

I. General information

NPI: 1184676975
Provider Name (Legal Business Name): GWENDOLYNN DELORES RANDALL CRNA, PHD,APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. GWENDOLYNN DELORES JOHNSON RANDALL

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 36TH ST
VERO BEACH FL
32960-4862
US

IV. Provider business mailing address

104 SUFFOLK DR
ROYAL PALM BEACH FL
33411-8262
US

V. Phone/Fax

Practice location:
  • Phone: 772-776-9621
  • Fax: 772-778-3494
Mailing address:
  • Phone: 561-628-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN3034802
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number17249
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number330397
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: