MEDICARE: IRINA RODRIGUEZ PA

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	363A00000X	Physician Assistant	PA9105237	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255632477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA RODRIGUEZ PA

Provider Business Mailing Address
First Line	:	1495 MALLARD LANDING BLVD
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-5220
Country	:	US
Telephone Number	:	786-614-3155
Fax Number	:

Provider Business Practice Location Address
First Line	:	1633 RACE TRACK RD
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3234
Country	:	US
Telephone Number	:	786-614-3155
Fax Number	:

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	02/16/2026

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Directions to “ IRINA RODRIGUEZ PA” Practice Location

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