Healthcare Provider Details

I. General information

NPI: 1841131984
Provider Name (Legal Business Name): ROBERTO LAZARO RODRIGUEZ BAEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15404 SW 19TH ST
MIRAMAR FL
33027-4302
US

IV. Provider business mailing address

15404 SW 19TH ST
MIRAMAR FL
33027-4302
US

V. Phone/Fax

Practice location:
  • Phone: 407-405-5565
  • Fax:
Mailing address:
  • Phone: 407-405-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11046500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: