Healthcare Provider Details

I. General information

NPI: 1023935749
Provider Name (Legal Business Name): ANGELISSE RODRIGUEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARC VAN SCOY DD68 VIA REXVILLE
BAYAMON PR
00957
US

IV. Provider business mailing address

PARC VAN SCOY DD68 VIA REXVILLE
BAYAMON PR
00957
US

V. Phone/Fax

Practice location:
  • Phone: 787-248-8995
  • Fax:
Mailing address:
  • Phone: 787-248-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number006018
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: