Provider Demographics
NPI:1437666427
Name:RANDOLPH, ZANETTA (ARNP)
Entity type:Individual
Prefix:
First Name:ZANETTA
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ZANETTA
Other - Middle Name:
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 WATFORD LN
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-9292
Mailing Address - Country:US
Mailing Address - Phone:407-792-8750
Mailing Address - Fax:
Practice Address - Street 1:11 JENKINS ST
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2412
Practice Address - Country:US
Practice Address - Phone:864-288-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily