Healthcare Provider Details

I. General information

NPI: 1659967610
Provider Name (Legal Business Name): BRIDGETTE STACEY RODRIGUEZ MS HUMAN SERVICES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 BLANDING BLVD STE 103
JACKSONVILLE FL
32210-1945
US

IV. Provider business mailing address

1717 BLANDING BLVD STE 103
JACKSONVILLE FL
32210-1945
US

V. Phone/Fax

Practice location:
  • Phone: 904-410-0362
  • Fax:
Mailing address:
  • Phone: 904-410-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: