Provider Demographics
NPI:1477127827
Name:RODRIGUEZ, JESSICA (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3654 SW 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3700
Mailing Address - Country:US
Mailing Address - Phone:772-210-7555
Mailing Address - Fax:772-266-8207
Practice Address - Street 1:3654 SW 30TH AVE
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3700
Practice Address - Country:US
Practice Address - Phone:772-210-7555
Practice Address - Fax:772-266-8207
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NX369OtherMEDICARE PTAN
15154379OtherCAQH
1407805021OtherGROUP NPI ASSOCIATION