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RANDOLPH DIABETES AND WELLNESS LLC
NPI 1609378991
Family Medicine - Adult Medicine in Tampa, FL

Active since March 02, 2018CLIA 10D2182314 · Waiver
13047 W LINEBAUGH AVE STE 102, TAMPA, FL 33626(813) 475-6542(813) 475-6874 Get Directions Write a Review

NPPES record last updated: May 12, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 12, 2021, Dec 3, 2020, Aug 20, 2019 and 1 more (4 updates tracked since 2018).

About Randolph Diabetes And Wellness Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RANDOLPH DIABETES AND WELLNESS LLC (NPI 1609378991) is a healthcare organization registered as an adult medicine in Tampa, Florida and active in the NPI registry since March 2018. The organization holds a CLIA Waiver certificate valid through April 19, 2028 and lists Kimberly T Randolph, Owner/manager, as its authorized official.

NPPES Registry Identity

NPI1609378991
Entity TypeOrganization
Primary Taxonomy207QA0505X
Legal Business NameRANDOLPH DIABETES AND WELLNESS LLC
Location Address13047 W LINEBAUGH AVE STE 102Tampa, FL 33626-4487
Mailing Address13047 W Linebaugh Ave Ste 102Tampa, FL 33626-4487 · (813) 475-6542 · Fax (813) 475-6874
Phone(813) 475-6542
Fax(813) 475-6874
Organization SubpartNo
Authorized OfficialKimberly T RandolphOwner/manager · (813) 846-7698
Enumeration DateMarch 2, 2018
Last NPPES UpdateMay 12, 20214 updates tracked since enumeration
NPPES CertifiedMay 12, 2021
✔ NPI 1609378991 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QA0505X
Definition
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.
Also ListedClinic/Center · Health ServiceTaxonomy 261QH0100X
Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X · License ARNP9318390 (FL)
13047 W LINEBAUGH AVE STE 102, Tampa, FL 33626
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2182314

Randolph Diabetes And Wellness · Tampa, FL
Active · expires Apr 19, 2028
CLIA Number10D2182314
Laboratory TypePhysician Office
Certificate Effective DateApril 20, 2026
Certificate Expiration DateApril 19, 2028
Laboratory DirectorKimberly T. Randolph
Laboratory Phone(813) 475-6542
Laboratory LocationRandolph Diabetes And Wellness13047 W Linebaugh Ave Ste 102, Tampa, FL 33626
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. KIMBERLY T RANDOLPH ARNP-C
Nurse Practitioner (Adult Health)
13047 W LINEBAUGH AVE STE 102
TAMPA, FL 33626
Hillsborough County (813) 475-6542
CHANG-WILLIAMS MEDICAL, LLC
Physician Assistant (Medical)
13047 W LINEBAUGH AVE STE 102
TAMPA, FL 33626
Hillsborough County (813) 334-6134

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Randolph Diabetes And Wellness LLC's NPI number?

The NPI number for Randolph Diabetes And Wellness LLC is 1609378991. It was assigned to this organization in the NPPES registry on March 2, 2018.

Where is Randolph Diabetes And Wellness LLC located?

Randolph Diabetes And Wellness LLC is located at 13047 W Linebaugh Ave Ste 102, Tampa, FL 33626. The listed phone number is (813) 475-6542.

What is Randolph Diabetes And Wellness LLC's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Does Randolph Diabetes And Wellness LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2182314) is associated with this NPI, valid through April 19, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Randolph Diabetes And Wellness LLC was last updated on May 12, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.