Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Marisa C Randazzo

Individual provider Gerontology Nurse Practitioner · NPI 1730983792

Marisa C Randazzo is a Nurse Practitioner in Philadelphia, Pennsylvania. Qualified in 2024, 2 years ago. Licensed in Pennsylvania.

Years since qualifying
2
Licensed in
PA
In the registry since
2025
Specialties on file
2
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Practice location Address checks out

3400 Spruce St
Philadelphia, PA 19104-4238
Phone: (215) 662-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence SP031541 (PA)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence SP031541 (PA)

Record details

NPI number1730983792
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedApril 1, 2025
Last updated in NPPESApril 1, 2025
Certification dateApril 1, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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