Provider Demographics
NPI:1447800164
Name:COLMENARES RODRIGUEZ, PAUL GAGARIN (FNP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GAGARIN
Last Name:COLMENARES RODRIGUEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10090 MADISON BANKS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-6940
Mailing Address - Country:US
Mailing Address - Phone:407-715-1683
Mailing Address - Fax:
Practice Address - Street 1:10090 MADISON BANKS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-6940
Practice Address - Country:US
Practice Address - Phone:407-715-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-14
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN-9529942163WR0006X
AZ16-743246ZC0007X
FLF09231243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant