Provider Demographics
NPI:1043755739
Name:RODRIGUEZ, JENNA LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 E MINERAL CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3401
Mailing Address - Country:US
Mailing Address - Phone:303-673-7823
Mailing Address - Fax:303-649-6954
Practice Address - Street 1:545 CREEKSIDE XING STE 206
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4274
Practice Address - Country:US
Practice Address - Phone:830-387-5270
Practice Address - Fax:830-387-5329
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776883163W00000X
TXF0117156363LF0000X
COC-APN.0004247-C-NP363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily