Healthcare Provider Details

I. General information

NPI: 1518952084
Provider Name (Legal Business Name): EARLYNE L RODRIGUEZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 N MILLS AVE
ORLANDO FL
32803-1853
US

IV. Provider business mailing address

11060 CYPRESS TRAIL DR
ORLANDO FL
32825-5025
US

V. Phone/Fax

Practice location:
  • Phone: 757-535-4987
  • Fax:
Mailing address:
  • Phone: 757-535-4987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2152602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: