Healthcare Provider Details

I. General information

NPI: 1023267747
Provider Name (Legal Business Name): MYRNA E. RODRIGUEZ RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

1101 TAMANGO DR TAMARIND ESTATE
WEST MELBOURNE FL
32904-8760
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-271-4550
Mailing address:
  • Phone: 321-373-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number07594
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: