Provider Demographics
NPI:1902449994
Name:RODRIGUEZ, IDANIA (APRNCB)
Entity Type:Individual
Prefix:
First Name:IDANIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:APRNCB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 W 51ST PL FL 2
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3601
Mailing Address - Country:US
Mailing Address - Phone:305-817-6560
Mailing Address - Fax:786-209-2080
Practice Address - Street 1:551 W 51ST PL FL 2
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3601
Practice Address - Country:US
Practice Address - Phone:305-817-6560
Practice Address - Fax:786-209-2080
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF10190230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3668OtherNPI