Provider Demographics
NPI:1932681582
Name:RODRIGUEZ, JESUS (ARNP)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21097 NE 27TH CT STE 320
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1206
Mailing Address - Country:US
Mailing Address - Phone:305-933-9440
Mailing Address - Fax:305-933-9424
Practice Address - Street 1:21097 NE 27TH CT STE 320
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1206
Practice Address - Country:US
Practice Address - Phone:305-933-9440
Practice Address - Fax:305-933-9424
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9386041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty