Provider Demographics
NPI:1891851556
Name:RODRIGUEZ, CHRISTA C (WHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTA
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12505 CARDINAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-0984
Mailing Address - Country:US
Mailing Address - Phone:214-724-5366
Mailing Address - Fax:
Practice Address - Street 1:4323 N JOSEY LN
Practice Address - Street 2:PLAZA 1, SUITE 306
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4633
Practice Address - Country:US
Practice Address - Phone:972-939-7011
Practice Address - Fax:972-939-2951
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551634363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08291OtherSTATE BOARD PRESCRIPTIVE NUMBER
TX146773001Medicaid
TX1891851556OtherNPI #
TX551634OtherSTATE BOARD OF NURSING LICENSE #