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Leslie Angelette Randolph-Moss

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

4600 Middleton Park Cir E Apt D250, Jacksonville, FL 32224-4684

PECOS Enrollment

This provider is enrolled in PECOS as LESLIE RANDOLPH-MOSS.

Based on the most recent information from CMS, provider Leslie Angelette Randolph-Moss is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1730283862
Provider Type
Individual
Full Name
Randolph-Moss, Leslie Angelette
Title
Mrs.
Credential
MPAS, PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
9/11/2006
Last Updated
10/18/2023

Contact Information

Practice Location

4600 Middleton Park Cir E Apt D250, Jacksonville, FL 32224-4684

(090) 461-0339

Unlisted Fax

Mailing Location

116 Clarendon Rd, St Johns, FL 32259-7079

(785) 226-2115

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA9113425 Florida
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 1061708 Kansas

Leslie Angelette Randolph-Moss

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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