Provider Demographics
NPI:1275314437
Name:RODRIGUEZ BARRIOS, KATISLEIDY
Entity Type:Individual
Prefix:
First Name:KATISLEIDY
Middle Name:
Last Name:RODRIGUEZ BARRIOS
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 1:3103 IVY CT
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-4017
Mailing Address - Country:US
Mailing Address - Phone:786-262-3597
Mailing Address - Fax:
Practice Address - Street 1:3103 IVY CT
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4017
Practice Address - Country:US
Practice Address - Phone:786-262-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028760363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care