Provider Demographics
NPI:1508869421
Name:RANDELL, ANDREA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LEE
Last Name:RANDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2770 CAPITAL MEDICAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8419
Mailing Address - Country:US
Mailing Address - Phone:850-878-8235
Mailing Address - Fax:850-878-1899
Practice Address - Street 1:2770 CAPITAL MEDICAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8419
Practice Address - Country:US
Practice Address - Phone:850-878-8235
Practice Address - Fax:850-878-1899
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000531759BMedicaid
FL05263470Medicaid
FL11907OtherBCBS INDIVIDUAL NUMBER
FL99039OtherGROUP BCBS NUMBER
FLP00625815OtherRAILROAD MEDICARE
GA000531759BMedicaid
GA000531759BMedicaid