Provider Demographics
NPI:1831184910
Name:HEARNE, RANDY (ARNP-C)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:HEARNE
Suffix:
Gender:M
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2029
Mailing Address - Country:US
Mailing Address - Phone:850-584-3278
Mailing Address - Fax:850-584-6814
Practice Address - Street 1:315 E ASH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2029
Practice Address - Country:US
Practice Address - Phone:850-584-3278
Practice Address - Fax:850-584-8171
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2961562363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9435ZMedicare ID - Type Unspecified
FLP14840Medicare UPIN