Provider Demographics
NPI:1093412900
Name:RANDOLPH, BRIANA PATRICIA
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:PATRICIA
Last Name:RANDOLPH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 BROADWAY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1148
Mailing Address - Country:US
Mailing Address - Phone:210-233-7000
Mailing Address - Fax:
Practice Address - Street 1:2520 BROADWAY ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1148
Practice Address - Country:US
Practice Address - Phone:210-233-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily