Provider Demographics
NPI:1902970007
Name:RODRIGUEZ BALLARD, MARILYN MARGARITA (APRN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:MARGARITA
Last Name:RODRIGUEZ BALLARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23343 NW COUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-9669
Mailing Address - Country:US
Mailing Address - Phone:386-454-0698
Mailing Address - Fax:
Practice Address - Street 1:2349 VILLAGE SQUARE PKWY STE 110-111
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6355
Practice Address - Country:US
Practice Address - Phone:904-385-2023
Practice Address - Fax:904-385-2454
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2849702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009298200Medicaid
FLE6615WMedicare PIN