OrganizationRandolph'S Family Health And WellnessNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3037 Lakeland Hills Blvd Ste 7a, Lakeland, FL 33805-2225(863) 860-4500PECOS EnrollmentBased on the most recent information from CMS, provider Randolph'S Family Health And Wellness does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1164169371Provider TypeOrganizationFull NameRandolph'S Family Health And WellnessSubpartNoEnumeration Date5/18/2022Last Updated4/22/2024Contact InformationPractice LocationPractice Address3037 Lakeland Hills Blvd Ste 7a, Lakeland, FL 33805-2225Phone(863) 860-4500FaxUnlisted FaxMailing LocationMailing Address12596 Us Highway 98 N, Lakeland, FL 33809-1089Phone(863) 860-4500FaxUnlisted FaxAuthorized OfficialNameRandolph, Amanda Lucille (Nurse Practitioner)Phone(863) 333-0032Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted Issuer