Healthcare Provider Details

I. General information

NPI: 1114365822
Provider Name (Legal Business Name): LAURA MARIA RODRIGUEZ-ROMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF FLORIDA 1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-7981
  • Fax: 352-265-7983
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: