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NPI Code Detail

MEDICARE: VICTORIA RANDLE FNP-C

MEDICARE:   VICTORIA  RANDLE  FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN199251GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083083810
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA RANDLE FNP-C
Provider Business Mailing Address
First Line : 5284 FLOYD RD SW UNIT 842
Second Line :
City : MABLETON
State : GA
Zip : 30126-6106
Country : US
Telephone Number : 770-726-3577
Fax Number : 770-522-6228
Provider Business Practice Location Address
First Line : 6130 HOTEL ST
Second Line :
City : AUSTELL
State : GA
Zip : 30106-4623
Country : US
Telephone Number : 770-726-3577
Fax Number : 770-522-6228
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2015
Last Update Date : 06/26/2025

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Directions to “ VICTORIA RANDLE FNP-C” Practice Location

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