MEDICARE: SAVANNAH ASHLEE RANDOLPH CRNP

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
1	363LA2200X	Adult Health Nurse Practitioner	908459	MS
2	363LA2200X	Adult Health Nurse Practitioner	247497	LA
3	363LA2200X	Adult Health Nurse Practitioner	36670	TN
4	363LA2200X	Adult Health Nurse Practitioner	1152595	TX
5	363LA2200X	Adult Health Nurse Practitioner	89183	NM
6	363LA2200X	Adult Health Nurse Practitioner	C-APN.0106544-C-NP	CO
7	363LA2200X	Adult Health Nurse Practitioner	1112879	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-112879	OTHER	AL	AL-LICENSE

General Provider Information

NPI Number	:	1164872529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH ASHLEE RANDOLPH CRNP

Provider Business Mailing Address
First Line	:	730 COOL SPRINGS BLVD STE 500
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7331
Country	:	US
Telephone Number	:	773-292-4800
Fax Number	:	312-564-4059

Provider Business Practice Location Address
First Line	:	2 CHASE CORPORATE DR
Second Line	:	SUITE 300
City	:	HOOVER
State	:	AL
Zip	:	35244-1016
Country	:	US
Telephone Number	:	773-292-4800
Fax Number	:	312-564-4059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2016
Last Update Date	:	06/26/2026

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