Provider Demographics
NPI:1952848335
Name:RODRIGUEZ-BORASZ, NICOLE JEAN (CNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JEAN
Last Name:RODRIGUEZ-BORASZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 SOUTHERN BLVD STE 4200
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-0135
Mailing Address - Country:US
Mailing Address - Phone:937-294-1489
Mailing Address - Fax:937-294-7999
Practice Address - Street 1:3737 SOUTHERN BLVD STE 4200
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-0135
Practice Address - Country:US
Practice Address - Phone:937-294-1489
Practice Address - Fax:937-294-7999
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH474950Medicare PIN