Provider Demographics
NPI:1548592991
Name:RODRIGUEZ, ANGELINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3215
Mailing Address - Country:US
Mailing Address - Phone:352-797-3500
Mailing Address - Fax:352-797-3526
Practice Address - Street 1:7945 S SUNCOAST BLVD STE A
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446
Practice Address - Country:US
Practice Address - Phone:352-382-5000
Practice Address - Fax:352-382-1940
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.015039207Q00000X
OH35.096487207Q00000X
FLME134023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0051599Medicaid
OHH010851Medicare PIN