Provider Demographics
NPI:1407982135
Name:RODRIGUEZ, PHILIP GARZA (FNP, DC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:GARZA
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:FNP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80410
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-2906
Mailing Address - Country:US
Mailing Address - Phone:817-770-6867
Mailing Address - Fax:214-260-6062
Practice Address - Street 1:1201 N WATSON RD STE 166
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6223
Practice Address - Country:US
Practice Address - Phone:817-770-6867
Practice Address - Fax:214-260-6062
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6478111N00000X
TXAP129266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP129266OtherNURSE PRACTIONER LICENSE