Provider Demographics
NPI:1750681714
Name:RANDOLPH, JOANNA (RN, MS, ANP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:RN, MS, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20055 LAKE CHABOT RD
Practice Address - Street 2:SUITE 230
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5331
Practice Address - Country:US
Practice Address - Phone:510-881-1490
Practice Address - Fax:510-889-5806
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2010009027363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health