Healthcare Provider Details

I. General information

NPI: 1043305469
Provider Name (Legal Business Name): JEANNETTE EDITH RODRIGUEZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W ANDERSON LN # 152
AUSTIN TX
78757-1180
US

IV. Provider business mailing address

125 S CLARK ST STE 900
CHICAGO IL
60603-4043
US

V. Phone/Fax

Practice location:
  • Phone: 512-988-5355
  • Fax:
Mailing address:
  • Phone: 512-988-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128687
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: