Provider Demographics
NPI:1912641994
Name:RODRIGUEZ, LAURA VIVIANA (APRN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:VIVIANA
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 1:5423 SW 153RD AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4116
Mailing Address - Country:US
Mailing Address - Phone:305-606-7512
Mailing Address - Fax:
Practice Address - Street 1:5423 SW 153RD AVENUE RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4116
Practice Address - Country:US
Practice Address - Phone:305-606-7512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019225363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care