=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003733403
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN MARIE HERNANDEZ RODRIGUEZ PSY.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2026
-----------------------------------------------------
Last Update Date | 07/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1441 HERITAGE BLVD
-----------------------------------------------------
City | IMMOKALEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34142-2260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-658-3056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11290 COLONIAL GATEWAY DR APT 6306
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33905-3954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-658-3056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------