Healthcare Provider Details

I. General information

NPI: 1700355641
Provider Name (Legal Business Name): EVELYN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 NW 151ST ST STE 203
MIAMI LAKES FL
33014-2442
US

IV. Provider business mailing address

5881 NW 151ST ST STE 203
MIAMI LAKES FL
33014-2442
US

V. Phone/Fax

Practice location:
  • Phone: 305-200-3141
  • Fax: 786-238-7885
Mailing address:
  • Phone: 305-200-3141
  • Fax: 786-238-7885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number9434723
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9434723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: