Provider Demographics
NPI:1689784910
Name:RANDLE, TAMMIE (CRNA)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:RANDLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E TYLER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-7214
Mailing Address - Country:US
Mailing Address - Phone:903-236-2736
Mailing Address - Fax:903-236-2286
Practice Address - Street 1:140 E TYLER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-7214
Practice Address - Country:US
Practice Address - Phone:903-236-2736
Practice Address - Fax:903-236-2286
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX054812367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered