Provider Demographics
NPI:1811343858
Name:RODRIGUEZ, CARLOS J (ARNP)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:J
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:5065 S STATE ROAD 7
Mailing Address - Street 2:SUITE 201,
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-5447
Mailing Address - Country:US
Mailing Address - Phone:561-753-7487
Mailing Address - Fax:561-753-8161
Practice Address - Street 1:160 JFK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6632
Practice Address - Country:US
Practice Address - Phone:561-439-0961
Practice Address - Fax:561-439-0963
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9300770363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health