Provider Demographics
NPI:1255146627
Name:RODRIGUEZ, THALIA FERNANDA (APRN)
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:FERNANDA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 CREEKVIEW PRESERVE DR APT 406
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7570
Mailing Address - Country:US
Mailing Address - Phone:321-682-9944
Mailing Address - Fax:
Practice Address - Street 1:1507 N JOHN YOUNG PKWY STE B
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3214
Practice Address - Country:US
Practice Address - Phone:305-908-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11037656363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health