Healthcare Provider Details

I. General information

NPI: 1124304431
Provider Name (Legal Business Name): BETH SUSAN RODRIGUEZ CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MEMORIAL MEDICAL PKWY
DAYTONA BEACH FL
32117-5167
US

IV. Provider business mailing address

301 MEMORIAL MEDICAL PKWY
DAYTONA BEACH FL
32117-5167
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0406
  • Fax:
Mailing address:
  • Phone: 407-975-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN1277432
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN1277432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: