Provider Demographics
NPI:1558367979
Name:RODRIGUEZ, MARIAN (APRN)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CLEMATIS ST STE 5-531
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5107
Mailing Address - Country:US
Mailing Address - Phone:561-671-4036
Mailing Address - Fax:
Practice Address - Street 1:225 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4616
Practice Address - Country:US
Practice Address - Phone:561-274-3100
Practice Address - Fax:561-266-6629
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9279205363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001869700Medicaid
FL001869700Medicaid