Provider Demographics
NPI:1609372168
Name:RODRIGUEZ, LEIDYS R (APRN)
Entity Type:Individual
Prefix:
First Name:LEIDYS
Middle Name:R
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 1:18901 SW 106TH AVE STE 229
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7665
Mailing Address - Country:US
Mailing Address - Phone:786-808-6575
Mailing Address - Fax:
Practice Address - Street 1:18901 SW 106TH AVE STE 229
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7665
Practice Address - Country:US
Practice Address - Phone:786-808-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018968363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily