Provider Demographics
NPI:1750255527
Name:RANDOLPH, RAEGINA SARAFINA
Entity type:Individual
Prefix:
First Name:RAEGINA
Middle Name:SARAFINA
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 APOLLO BEACH BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-3037
Mailing Address - Country:US
Mailing Address - Phone:813-444-2234
Mailing Address - Fax:
Practice Address - Street 1:1312 APOLLO BEACH BLVD STE C
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-3037
Practice Address - Country:US
Practice Address - Phone:813-444-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW203311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty