Healthcare Provider Details

I. General information

NPI: 1912814518
Provider Name (Legal Business Name): MANUEL FELIPE RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 N ORLANDO AVE
WINTER PARK FL
32789-2921
US

IV. Provider business mailing address

839 N ORLANDO AVE
WINTER PARK FL
32789-2921
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-1862
  • Fax: 407-673-8140
Mailing address:
  • Phone: 407-647-1862
  • Fax: 407-673-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11050082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: