Healthcare Provider Details

I. General information

NPI: 1447800164
Provider Name (Legal Business Name): PAUL GAGARIN COLMENARES RODRIGUEZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2019
Last Update Date: 10/01/2023
Certification Date: 10/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10090 MADISON BANKS ST
ORLANDO FL
32827-6940
US

IV. Provider business mailing address

10090 MADISON BANKS ST
ORLANDO FL
32827-6940
US

V. Phone/Fax

Practice location:
  • Phone: 407-715-1683
  • Fax:
Mailing address:
  • Phone: 407-715-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN-9529942
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number16-743
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09231243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: