Provider Demographics
NPI:1164011367
Name:RODNEY, MARCIA PETRA
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:PETRA
Last Name:RODNEY
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 1:5240 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4327
Mailing Address - Country:US
Mailing Address - Phone:754-244-5698
Mailing Address - Fax:
Practice Address - Street 1:5240 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4327
Practice Address - Country:US
Practice Address - Phone:754-244-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9370571363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner