Provider Demographics
NPI:1073559373
Name:CARTER, RANDALL ALLEN (PA-C)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:ALLEN
Last Name:CARTER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6909 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2213
Mailing Address - Country:US
Mailing Address - Phone:813-999-1163
Mailing Address - Fax:813-999-1073
Practice Address - Street 1:6909 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2213
Practice Address - Country:US
Practice Address - Phone:813-999-1163
Practice Address - Fax:813-999-1073
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1045363AM0700X
FLPA9118770363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1045OtherOKLAHOMA BOARD OF MEDICAL LICENSURE