Provider Demographics
NPI:1417448796
Name:RODRIGUEZ, IENA A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:IENA
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KINGSLEY LN STE 312
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4618
Mailing Address - Country:US
Mailing Address - Phone:757-354-2885
Mailing Address - Fax:
Practice Address - Street 1:110 KINGSLEY LN STE 312
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4618
Practice Address - Country:US
Practice Address - Phone:757-354-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175766363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily