Provider Demographics
NPI:1437866068
Name:BUENO RODRIGUEZ, JOSE CARLOS SR (APRN)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS
Last Name:BUENO RODRIGUEZ
Suffix:SR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 SW 18TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6612
Mailing Address - Country:US
Mailing Address - Phone:915-305-0802
Mailing Address - Fax:
Practice Address - Street 1:11400 SW 18TH CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6612
Practice Address - Country:US
Practice Address - Phone:915-305-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily