Provider Demographics
NPI:1104345370
Name:TORRES, RANDY SCOTT JR (FNP-C)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:SCOTT
Last Name:TORRES
Suffix:JR
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 N SELFRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1006
Mailing Address - Country:US
Mailing Address - Phone:734-560-7720
Mailing Address - Fax:
Practice Address - Street 1:29877 TELEGRAPH RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7659
Practice Address - Country:US
Practice Address - Phone:248-354-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704261502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily