Provider Demographics
NPI:1164084679
Name:RODRIGUEZ, YAHAIRA (ARNP)
Entity Type:Individual
Prefix:
First Name:YAHAIRA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 MORRISON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4849
Mailing Address - Country:US
Mailing Address - Phone:813-681-6474
Mailing Address - Fax:813-654-8473
Practice Address - Street 1:214 MORRISON RD STE 104
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4849
Practice Address - Country:US
Practice Address - Phone:813-681-6474
Practice Address - Fax:813-654-8473
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9210067163W00000X
FLAPRN11007472363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty