Provider Demographics
NPI:1144248824
Name:BANKS, RANDY GENE (PA-C)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:GENE
Last Name:BANKS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1200 GULF BREEZE PKWY STE A
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4851
Practice Address - Country:US
Practice Address - Phone:800-243-7546
Practice Address - Fax:850-484-8223
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2025-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 3145363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant