Provider Demographics
NPI:1518713106
Name:RODRIGUEZ, GISSELLE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:GISSELLE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 MONTE CARLO N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-1119
Mailing Address - Country:US
Mailing Address - Phone:727-851-0602
Mailing Address - Fax:
Practice Address - Street 1:13013 SEMINOLE BLVD # 1041
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2124
Practice Address - Country:US
Practice Address - Phone:727-851-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-09-03
Deactivation Date:2024-05-06
Deactivation Code:
Reactivation Date:2024-06-11
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032562363L00000X
FL9580211163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery