MEDICARE: MELISSA RODRIGUEZ FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1179133	TX

General Provider Information

NPI Number	:	1841012648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA RODRIGUEZ FNP-C

Provider Business Mailing Address
First Line	:	14943 DANCERS IMAGE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-0932
Country	:	US
Telephone Number	:	210-323-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 SW 24TH ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-5136
Country	:	US
Telephone Number	:	210-432-7801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	03/13/2025

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