Healthcare Provider Details

I. General information

NPI: 1801226550
Provider Name (Legal Business Name): JENNIFER RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2013
Last Update Date: 11/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

IV. Provider business mailing address

9423 NW 6TH PL
GAINESVILLE FL
32607-1348
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9294734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: