Healthcare Provider Details

I. General information

NPI: 1043002629
Provider Name (Legal Business Name): FABIOLA RODRIGUEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33409-6522
US

IV. Provider business mailing address

123 SE 4TH AVE
CAPE CORAL FL
33990-1038
US

V. Phone/Fax

Practice location:
  • Phone: 800-531-1587
  • Fax:
Mailing address:
  • Phone: 239-537-6281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11039581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: