Sumner, Warren Randall

Sumner, Warren Randall is an individual health care provider with primary practice located at 3003 W Dr Martin Luther King Jr Blvd Mab 2Nd Floor, Tampa FL 33607-6307. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Sumner, Warren Randall can be contacted via phone (813) 321-6580.

Contact Information

Primary practice address
3003 W Dr Martin Luther King Jr Blvd Mab 2Nd Floor Tampa FL 33607-6307
Phone: (813) 321-6580
Fax: (813) 443-8185
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 003541 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 003541 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA9108734 Florida

Profile Details

NPI number 1609866219
LBN Legal business name Sumner, Warren Randall
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 25th, 2005
Last updated Feb 10th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609866219 NPPES
Georgia Other 404215 WELLCARE
Georgia MEDICAID 015768600 WELLCARE
Georgia MEDICAID 100001160D WELLCARE
Georgia Other 01067693 WELLCARE
Georgia Other P00679501 WELLCARE
Georgia MEDICAID 0155PA WELLCARE

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