Provider Demographics
NPI:1043023500
Name:RANDLE, VALERIA NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:VALERIA
Middle Name:NICOLE
Last Name:RANDLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 WALKER AVE NW
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-4610
Mailing Address - Country:US
Mailing Address - Phone:386-364-8775
Mailing Address - Fax:
Practice Address - Street 1:807 WALKER AVE NW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4610
Practice Address - Country:US
Practice Address - Phone:386-364-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035753363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health