Provider Demographics
NPI:1295154094
Name:RODRIGUEZ HERNANDEZ, HERIBERTO (NP)
Entity type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:RODRIGUEZ HERNANDEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FOUNTAINBLEAU BLVD STE 1F
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4511
Mailing Address - Country:US
Mailing Address - Phone:786-389-8242
Mailing Address - Fax:
Practice Address - Street 1:175 FOUNTAINBLEAU BLVD STE 1F
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4511
Practice Address - Country:US
Practice Address - Phone:786-389-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL645037363LF0000X
FLF07201323363LF0000X
FLAPRN11010128363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily