Provider Demographics
NPI:1437594306
Name:HERNANDEZ RODRIGUEZ, MARILIN MARIANA (MD)
Entity Type:Individual
Prefix:
First Name:MARILIN
Middle Name:MARIANA
Last Name:HERNANDEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8726 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1714
Mailing Address - Country:US
Mailing Address - Phone:813-712-1726
Mailing Address - Fax:
Practice Address - Street 1:8726 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1714
Practice Address - Country:US
Practice Address - Phone:813-712-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN561208D00000X
FLME135985208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012351000Medicaid