Healthcare Provider Details

I. General information

NPI: 1861052243
Provider Name (Legal Business Name): SARA RODRIGUEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14107 CORTEZ BLVD
BROOKSVILLE FL
34613-2707
US

IV. Provider business mailing address

18082 FENDERS WAY
LAND O LAKES FL
34638-7665
US

V. Phone/Fax

Practice location:
  • Phone: 352-549-9962
  • Fax:
Mailing address:
  • Phone: 813-731-2912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: