Provider Demographics
NPI:1184705659
Name:RANDOLPH, SARA JO (RN, CNOR, CRNFA)
Entity type:Individual
Prefix:MRS
First Name:SARA JO
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:RN, CNOR, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 SE 17TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9107
Mailing Address - Country:US
Mailing Address - Phone:352-867-0444
Mailing Address - Fax:352-867-5522
Practice Address - Street 1:2300 SE 17TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-9107
Practice Address - Country:US
Practice Address - Phone:352-867-0444
Practice Address - Fax:352-867-5522
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86312-2163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant