Healthcare Provider Details

I. General information

NPI: 1679098701
Provider Name (Legal Business Name): NATHALI RODRIGUEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SIMMONS LOOP STE 207
RIVERVIEW FL
33578-9498
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 813-868-3052
  • Fax: 813-868-3046
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number021157
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: