Provider Demographics
NPI:1316195878
Name:RODRIGUEZ, CHRISTOPHER LYNN
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LYNN
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7431 N UNIVERSITY DR
Mailing Address - Street 2:STE 300
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2956
Mailing Address - Country:US
Mailing Address - Phone:954-776-7566
Mailing Address - Fax:954-776-7544
Practice Address - Street 1:7431 N UNIVERSITY DR
Practice Address - Street 2:STE 300
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2956
Practice Address - Country:US
Practice Address - Phone:954-776-7566
Practice Address - Fax:954-776-7544
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT 9104753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9104753OtherDEPT OF HEALTH