Provider Demographics
NPI:1467091512
Name:RODRIGUEZ, JOLEEN A (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:JOLEEN
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:JOLEEN
Other - Middle Name:A
Other - Last Name:MAZIANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1477 W COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6016
Mailing Address - Country:US
Mailing Address - Phone:520-792-3293
Mailing Address - Fax:520-747-3260
Practice Address - Street 1:620 N CRAYCROFT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1448
Practice Address - Country:US
Practice Address - Phone:520-519-8550
Practice Address - Fax:520-747-3260
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ232225363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology