Johnson Randall, Gwendolynn Delores

Johnson Randall, Gwendolynn Delores is an individual health care provider with primary practice located at 1000 36Th St , Vero Beach FL 32960-4862. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Johnson Randall, Gwendolynn Delores can be contacted via phone (772) 776-9621.

Contact Information

Primary practice address
1000 36Th St Vero Beach FL 32960-4862
Phone: (772) 776-9621
Fax: (772) 778-3494
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 17249 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X APRN3034802 Florida

Profile Details

NPI number 1184676975
LBN Legal business name Johnson Randall, Gwendolynn Delores
Credentials CRNA, PHD,APRN
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2006
Last updated May 15th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184676975 NPPES
Florida Other G3421 BCBS

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