Provider Demographics
NPI:1619571254
Name:RODRIGUEZ, VANESSA ALEXIS
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:ALEXIS
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 WINDLEA DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-4044
Mailing Address - Country:US
Mailing Address - Phone:469-964-6854
Mailing Address - Fax:
Practice Address - Street 1:6225 N JOSEY LN STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-2482
Practice Address - Country:US
Practice Address - Phone:469-495-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020328363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily