Provider Demographics
NPI:1649710666
Name:O'HARA-RODRIGUEZ, ROBINSON
Entity type:Individual
Prefix:
First Name:ROBINSON
Middle Name:
Last Name:O'HARA-RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 RIVER RUN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6042
Mailing Address - Country:US
Mailing Address - Phone:305-720-6210
Mailing Address - Fax:
Practice Address - Street 1:236 UFFELMAN DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6566
Practice Address - Country:US
Practice Address - Phone:931-647-6305
Practice Address - Fax:931-245-1153
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3179363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant