Provider Demographics
NPI:1639613375
Name:RODRIGUEZ, MIRTHA NOEMI (ARNP)
Entity Type:Individual
Prefix:
First Name:MIRTHA
Middle Name:NOEMI
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19654 LANSDOWNE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-3716
Mailing Address - Country:US
Mailing Address - Phone:407-496-8847
Mailing Address - Fax:
Practice Address - Street 1:19654 LANSDOWNE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32833-3716
Practice Address - Country:US
Practice Address - Phone:407-496-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9236188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily