Healthcare Provider Details

I. General information

NPI: 1316307309
Provider Name (Legal Business Name): STEPHANIE MICHELLE RODRIQUEZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/17/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRET WHITE RD
HONOLULU HI
95859
US

IV. Provider business mailing address

598 W CHATFIELD ST
VAIL AZ
85641-6755
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-7076
  • Fax:
Mailing address:
  • Phone: 602-509-5184
  • Fax: 520-533-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number99520
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN154919
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: