Provider Demographics
NPI:1033883491
Name:HOPKINS-RANDOLPH, VILLA L
Entity Type:Individual
Prefix:MRS
First Name:VILLA
Middle Name:L
Last Name:HOPKINS-RANDOLPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 JASMINE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3421
Mailing Address - Country:US
Mailing Address - Phone:386-405-3684
Mailing Address - Fax:
Practice Address - Street 1:929 JASMINE AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-3421
Practice Address - Country:US
Practice Address - Phone:386-405-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator