Provider Demographics
NPI:1083178388
Name:RODRIGUEZ, FERNELLE C (FNP-BC, MSN, RN-BC)
Entity Type:Individual
Prefix:MR
First Name:FERNELLE
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:FNP-BC, MSN, RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3821
Mailing Address - Country:US
Mailing Address - Phone:585-360-6818
Mailing Address - Fax:
Practice Address - Street 1:121 FRENCH RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3821
Practice Address - Country:US
Practice Address - Phone:585-360-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339319-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily