Healthcare Provider Details

I. General information

NPI: 1821658170
Provider Name (Legal Business Name): MARIA J RODRIGUEZ DE VERA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10931 DYLAN LOREN CIR
ORLANDO FL
32825-4449
US

IV. Provider business mailing address

3361 BELLINGHAM DR
ORLANDO FL
32825-7168
US

V. Phone/Fax

Practice location:
  • Phone: 407-218-4444
  • Fax: 321-284-1514
Mailing address:
  • Phone: 407-346-8517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11002814
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: