Provider Demographics
NPI:1811876121
Name:RODRIGUEZ TARDI, NANICHI CRISTAL
Entity type:Individual
Prefix:
First Name:NANICHI
Middle Name:CRISTAL
Last Name:RODRIGUEZ TARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CALLE COQUI MELODIOSO
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3179
Mailing Address - Country:US
Mailing Address - Phone:605-319-1660
Mailing Address - Fax:
Practice Address - Street 1:656 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4521
Practice Address - Country:US
Practice Address - Phone:605-319-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR519162367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered