Provider Demographics
NPI:1932855103
Name:RODRIGUEZ CARRASQUILLO, LUISALI (PA)
Entity Type:Individual
Prefix:
First Name:LUISALI
Middle Name:
Last Name:RODRIGUEZ CARRASQUILLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9838 OLD BAYMEADOWS RD # 276
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8101
Mailing Address - Country:US
Mailing Address - Phone:904-730-5115
Mailing Address - Fax:
Practice Address - Street 1:9550 BAYMEADOWS RD STE 9
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0748
Practice Address - Country:US
Practice Address - Phone:904-730-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9106350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant