Healthcare Provider Details

I. General information

NPI: 1942788005
Provider Name (Legal Business Name): PAYTON RODRIGUEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S WOODLAND BLVD STE 4
DELAND FL
32720-7464
US

IV. Provider business mailing address

1205 S WOODLAND BLVD STE 3
DELAND FL
32720-7464
US

V. Phone/Fax

Practice location:
  • Phone: 386-202-6025
  • Fax:
Mailing address:
  • Phone: 386-202-6025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9394625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: