Provider Demographics
NPI:1629430707
Name:RODRIGUEZ, ROSITA (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:ROSITA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 N CENTRAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4405
Mailing Address - Country:US
Mailing Address - Phone:407-933-1221
Mailing Address - Fax:407-933-5613
Practice Address - Street 1:1121 N CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4405
Practice Address - Country:US
Practice Address - Phone:407-933-1221
Practice Address - Fax:407-933-5613
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9193466363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology