Provider Demographics
NPI:1790237683
Name:RANDALL, ABIGAIL (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANISTER DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-6681
Mailing Address - Country:US
Mailing Address - Phone:205-527-3145
Mailing Address - Fax:
Practice Address - Street 1:8513 OLD COUNTRY MNR
Practice Address - Street 2:APT 410
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2992
Practice Address - Country:US
Practice Address - Phone:205-527-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9363644363LF0000X
TN22343363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily