Healthcare Provider Details

I. General information

NPI: 1295246643
Provider Name (Legal Business Name): TRACY RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

IV. Provider business mailing address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-7430
  • Fax:
Mailing address:
  • Phone: 407-317-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: