MEDICARE: MS. JENNIFER RODRIGUEZ FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP144784	TX

General Provider Information

NPI Number	:	1144852104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER RODRIGUEZ FNP-BC

Provider Business Mailing Address
First Line	:	4102 S NEW BRAUNFELS AVE STE 110-142
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4102 S NEW BRAUNFELS AVE STE 110-142
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1707
Country	:	US
Telephone Number	:	210-254-8924
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	02/07/2020

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