Healthcare Provider Details

I. General information

NPI: 1306435151
Provider Name (Legal Business Name): EILEEN M RODRIGUEZ A-GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 HARDEN BLVD
LAKELAND FL
33803-7952
US

IV. Provider business mailing address

1324 LAKELAND HILLS BLVD MANAGED CARE DEPT
LAKELAND FL
33805-4543
US

V. Phone/Fax

Practice location:
  • Phone: 863-284-3950
  • Fax: 863-284-3951
Mailing address:
  • Phone: 863-687-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11011104
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11011104
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: