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General NPI Number Information
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NPI Number | 1740973700
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Entity Type | Individual
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Provider Name | JACSELY MARIE FLORES RODRIGUEZ APRN
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Gender | Female
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 200 S PARK RD STE 200
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8541
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Country | US
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Telephone | 866-986-2263
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Fax |
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Provider Business Mailing Address
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Address Line | 12307 SUMTER SQUARE DR E
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City | JACKSONVILLE
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State | FL
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Zip | 32218-6131
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Country | US
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Telephone | 904-226-9950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11025180
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License Number State | FL
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