Provider Demographics
NPI:1043245962
Name:RODRIGUEZ, FELIPE AURELIO (PA)
Entity Type:Individual
Prefix:MR
First Name:FELIPE
Middle Name:AURELIO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 409036
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9036
Mailing Address - Country:US
Mailing Address - Phone:352-369-0948
Mailing Address - Fax:
Practice Address - Street 1:NORTH FL REGIONAL MEDICAL CENTER
Practice Address - Street 2:6500 NEWBERRY RD, EMERGENCY DEPT
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-369-0948
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00086325OtherRRMCR
FLP34106Medicare UPIN
FLE5713YMedicare ID - Type Unspecified
FLE5713XMedicare PIN