Healthcare Provider Details

I. General information

NPI: 1568729036
Provider Name (Legal Business Name): IDANIA MEJIAS-RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR STE 280
JACKSONVILLE FL
32207-8350
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-697-3600
  • Fax: 904-687-3927
Mailing address:
  • Phone: 904-244-4195
  • Fax: 904-244-4908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME126401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: