Provider Demographics
NPI:1518618511
Name:RODRIGUEZ, MINERVA (APRN-FNP-BC)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:APRN-FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 EL PASO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2818
Mailing Address - Country:US
Mailing Address - Phone:915-521-2652
Mailing Address - Fax:
Practice Address - Street 1:5115 EL PASO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2818
Practice Address - Country:US
Practice Address - Phone:915-521-2652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily