Provider Demographics
NPI:1518539949
Name:RODRIGUEZ, JUAN CARLOS (APRN)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:RODRIGUEZ
Suffix:
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 1:2320 NE 9TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3590
Mailing Address - Country:US
Mailing Address - Phone:954-563-4500
Mailing Address - Fax:954-530-0399
Practice Address - Street 1:2320 NE 9TH ST STE 300
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3590
Practice Address - Country:US
Practice Address - Phone:954-563-4500
Practice Address - Fax:954-530-0399
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010091363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty