Healthcare Provider Details

I. General information

NPI: 1417812264
Provider Name (Legal Business Name): KATILYN ANN RODRIGUEZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 ENGLE RD STE 304
FORT WAYNE IN
46804-2227
US

IV. Provider business mailing address

7230 ENGLE RD STE 304
FORT WAYNE IN
46804-2227
US

V. Phone/Fax

Practice location:
  • Phone: 260-344-4146
  • Fax:
Mailing address:
  • Phone: 260-344-4146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28209272A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: