Healthcare Provider Details

I. General information

NPI: 1750261814
Provider Name (Legal Business Name): DAINELIS ORTEGA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 VIRGINIA AVE
FORT PIERCE FL
34982-3522
US

IV. Provider business mailing address

1008 VIRGINIA AVE
FORT PIERCE FL
34982-3522
US

V. Phone/Fax

Practice location:
  • Phone: 772-666-1801
  • Fax: 754-222-6417
Mailing address:
  • Phone: 772-666-1801
  • Fax: 754-222-6417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11041756
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: