Provider Demographics
NPI:1235836032
Name:RODRIGUEZ, GRETELL BASTER (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:GRETELL
Middle Name:BASTER
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4580 NW 79TH AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6326
Mailing Address - Country:US
Mailing Address - Phone:305-490-8252
Mailing Address - Fax:
Practice Address - Street 1:3053 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1257
Practice Address - Country:US
Practice Address - Phone:786-534-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily