Provider Demographics
NPI:1235124207
Name:FLORENDO, RANDY ESTACION (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:ESTACION
Last Name:FLORENDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 SAVANNAH WEST CT
Mailing Address - Street 2:SUITE F
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-7387
Mailing Address - Country:US
Mailing Address - Phone:615-643-5008
Mailing Address - Fax:615-643-4100
Practice Address - Street 1:832 SAVANNAH WEST CT
Practice Address - Street 2:SUITE F
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172
Practice Address - Country:US
Practice Address - Phone:615-483-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31309208D00000X, 207P00000X, 208000000X
KY49518207P00000X, 207R00000X
TN31309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3848225Medicaid
TN4108174OtherTENN CARE
H06642Medicare UPIN
TN3848225Medicaid