Healthcare Provider Details

I. General information

NPI: 1780596205
Provider Name (Legal Business Name): YANARA CHONG RODRIGUEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 BRENTON POINTE CV
ORLANDO FL
32829-8020
US

IV. Provider business mailing address

6311 BRENTON POINTE CV
ORLANDO FL
32829-8020
US

V. Phone/Fax

Practice location:
  • Phone: 407-485-8312
  • Fax:
Mailing address:
  • Phone: 407-485-8312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049319
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: