Provider Demographics
NPI:1417522871
Name:UTRA RODRIGUEZ, ANNERYS B (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANNERYS
Middle Name:B
Last Name:UTRA RODRIGUEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9834 PATRICIAN DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5730
Mailing Address - Country:US
Mailing Address - Phone:813-270-1218
Mailing Address - Fax:
Practice Address - Street 1:9834 PATRICIAN DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-5730
Practice Address - Country:US
Practice Address - Phone:813-270-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012296363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care