Provider Demographics
NPI:1194198606
Name:RODRIGUEZ, JAVIER (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3011
Mailing Address - Country:US
Mailing Address - Phone:615-438-4193
Mailing Address - Fax:
Practice Address - Street 1:2523 WENDELL AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3011
Practice Address - Country:US
Practice Address - Phone:615-438-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20532363LA2100X
KY3009896363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care