Provider Demographics
NPI:1588022578
Name:RODRIGUEZ, RENNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RENNE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HELMIG ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-6723
Mailing Address - Country:US
Mailing Address - Phone:516-757-2986
Mailing Address - Fax:
Practice Address - Street 1:95 HELMIG ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-6723
Practice Address - Country:US
Practice Address - Phone:516-757-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY626436-1163WR0006X
NYF345998-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant