Provider Demographics
NPI:1992354948
Name:RANDAZZO, JOSEPH C JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:C
Last Name:RANDAZZO
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6055
Mailing Address - Country:US
Mailing Address - Phone:813-877-6748
Mailing Address - Fax:813-875-0359
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 320
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6055
Practice Address - Country:US
Practice Address - Phone:813-877-6748
Practice Address - Fax:813-875-0359
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2024-09-10
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Provider Licenses
StateLicense IDTaxonomies
FL9112498363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104526300Medicaid