Provider Demographics
NPI:1649038308
Name:RODRIGUEZ, STACY L (NP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7900 W JEFFERSON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4128
Practice Address - Country:US
Practice Address - Phone:260-969-7216
Practice Address - Fax:260-969-7230
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71015168A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily