Provider Demographics
NPI:1609003318
Name:RODRIGUEZ, RAYMOND (ACNP)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 BIRD RD
Mailing Address - Street 2:SUITE 722
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3582
Mailing Address - Country:US
Mailing Address - Phone:305-559-1857
Mailing Address - Fax:305-559-1887
Practice Address - Street 1:11760 BIRD RD
Practice Address - Street 2:SUITE 722
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-559-1857
Practice Address - Fax:305-559-1887
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9265567363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care