Provider Demographics
NPI:1114961695
Name:RANDALL, LAUREN BROOKE (CAA)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:BROOKE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:BROOKE
Other - Last Name:HOJDILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAA
Mailing Address - Street 1:15605 HAMPTON VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1616
Mailing Address - Country:US
Mailing Address - Phone:724-544-8684
Mailing Address - Fax:
Practice Address - Street 1:12902 MAGNOLIA DRIVE
Practice Address - Street 2:ANESTHESIA; MOFFITT CANCER CENTER
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:36612
Practice Address - Country:US
Practice Address - Phone:813-754-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004122367H00000X
FLAA-8367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant