Healthcare Provider Details

I. General information

NPI: 1790693851
Provider Name (Legal Business Name): ALYSSA RODRIGUEZ-URICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 US HIGHWAY 301 S STE 350
RIVERVIEW FL
33578-6300
US

IV. Provider business mailing address

8615 MALLARD RESERVE DR UNIT 102
TAMPA FL
33614-2341
US

V. Phone/Fax

Practice location:
  • Phone: 813-328-2073
  • Fax:
Mailing address:
  • Phone: 813-927-1447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9122214
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: