Provider Demographics
NPI:1437636115
Name:RODRIGUEZ, ELLIOT (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1280
Mailing Address - Country:US
Mailing Address - Phone:614-293-8305
Mailing Address - Fax:614-293-3124
Practice Address - Street 1:376 W.10TH AVENUE
Practice Address - Street 2:760 PRIOR HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1238
Practice Address - Country:US
Practice Address - Phone:614-293-8305
Practice Address - Fax:614-293-3124
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022648363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care