Healthcare Provider Details

I. General information

NPI: 1770120172
Provider Name (Legal Business Name): ODALYS RODRIGUEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NW 10TH AVE
MIAMI FL
33136-1015
US

IV. Provider business mailing address

1600 NW 10TH AVE
MIAMI FL
33136-1015
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6388
  • Fax: 305-243-6372
Mailing address:
  • Phone: 305-243-6388
  • Fax: 305-243-6372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: