Provider Demographics
NPI:1083100309
Name:SANTANA RODRIGUEZ, NICOLE MARI (DC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARI
Last Name:SANTANA RODRIGUEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9012
Mailing Address - Country:US
Mailing Address - Phone:386-295-7176
Mailing Address - Fax:
Practice Address - Street 1:4618 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9012
Practice Address - Country:US
Practice Address - Phone:941-405-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor