Healthcare Provider Details

I. General information

NPI: 1407655731
Provider Name (Legal Business Name): ALICE RODRIGUEZ APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23265 HIGHWAY 76 E
CLINTON SC
29325-7532
US

IV. Provider business mailing address

125 WREN SCHOOL RD
PIEDMONT SC
29673
US

V. Phone/Fax

Practice location:
  • Phone: 864-393-1020
  • Fax:
Mailing address:
  • Phone: 864-884-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number30096
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: