Provider Demographics
NPI:1942254651
Name:SCYPHERS, RODNEY LEE (ARNP-C, MSN)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:LEE
Last Name:SCYPHERS
Suffix:
Gender:M
Credentials:ARNP-C, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SUWANNEE AVE NW
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32008-3265
Mailing Address - Country:US
Mailing Address - Phone:386-935-1607
Mailing Address - Fax:386-935-1667
Practice Address - Street 1:208 SUWANNEE AVE NW
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:FL
Practice Address - Zip Code:32008-3265
Practice Address - Country:US
Practice Address - Phone:386-935-1607
Practice Address - Fax:386-935-1667
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2934442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303822000Medicaid
FLY036LOtherBLUE CROSS BLUE SHIELD
FLAA485Medicare ID - Type UnspecifiedPART B GROUP NUMBER
FLS82533Medicare UPIN
FLE2683WMedicare ID - Type UnspecifiedPART B GROUP MEMBER