Healthcare Provider Details

I. General information

NPI: 1295974616
Provider Name (Legal Business Name): JULIA JASKWHICH RODRIGUEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 ASHLEY RIVER RD
CHARLESTON SC
29407-5902
US

IV. Provider business mailing address

1620 ASHLEY RIVER RD BUILDING J
CHARLESTON SC
29407-5902
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-9177
  • Fax: 843-571-2742
Mailing address:
  • Phone: 843-556-8177
  • Fax: 843-571-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN109735
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4422
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: