Provider Demographics
NPI:1962947770
Name:HERMAN, RANDI MICHELLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:MICHELLE
Last Name:HERMAN
Suffix:
Gender:F
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 1:20751 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-7893
Mailing Address - Country:US
Mailing Address - Phone:623-463-5000
Mailing Address - Fax:
Practice Address - Street 1:20751 W MARKET ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-7893
Practice Address - Country:US
Practice Address - Phone:623-463-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN153699163W00000X
AZAP9870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse