Provider Demographics
NPI:1871182550
Name:RODRIGUEZ, BRISEIDA
Entity Type:Individual
Prefix:
First Name:BRISEIDA
Middle Name:
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 1:18033 PROMENADE PARK LN APT 404
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-7982
Mailing Address - Country:US
Mailing Address - Phone:787-422-9496
Mailing Address - Fax:
Practice Address - Street 1:18033 PROMENADE PARK LN APT 404
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-7982
Practice Address - Country:US
Practice Address - Phone:787-422-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9449047163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Single Specialty