Provider Demographics
NPI:1760221162
Name:RODRIGUEZ, LISANDRA (APRN)
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:RODRIGUEZ
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 1:7900 SW 57TH AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5546
Mailing Address - Country:US
Mailing Address - Phone:305-662-3984
Mailing Address - Fax:
Practice Address - Street 1:7900 SW 57TH AVE STE 21
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5546
Practice Address - Country:US
Practice Address - Phone:305-662-3984
Practice Address - Fax:305-665-7239
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031870363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care