=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710763180
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY GRACE RODRIGUEZ FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2023
-----------------------------------------------------
Last Update Date | 09/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 137 WILLIS AVE
-----------------------------------------------------
City | MINEOLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11501-2677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-518-9039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8946 241ST ST
-----------------------------------------------------
City | BELLEROSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11426-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-752-2008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | F351216
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------