Healthcare Provider Details

I. General information

NPI: 1124698238
Provider Name (Legal Business Name): JESSIEL RODRIGUEZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 SW 10TH ST
PLANTATION FL
33324-3279
US

IV. Provider business mailing address

8100 SW 10TH ST
PLANTATION FL
33324-3279
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6090
  • Fax: 305-243-6597
Mailing address:
  • Phone: 305-243-6090
  • Fax: 305-243-6597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11013323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: