Healthcare Provider Details

I. General information

NPI: 1003733403
Provider Name (Legal Business Name): JOAN MARIE HERNANDEZ RODRIGUEZ PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 HERITAGE BLVD
IMMOKALEE FL
34142-2260
US

IV. Provider business mailing address

11290 COLONIAL GATEWAY DR APT 6306
FORT MYERS FL
33905-3954
US

V. Phone/Fax

Practice location:
  • Phone: 239-658-3056
  • Fax:
Mailing address:
  • Phone: 239-658-3056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: