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NPI Code Detail

MEDICARE: ELLIOT RODRIGUEZ AG-ACNP

MEDICARE: ELLIOT RODRIGUEZ AG-ACNP
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
1363LA2100XAcute Care Nurse PractitionerAPRN.CNP.022648OH

General Provider Information

NPI Number : 1437636115
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIOT RODRIGUEZ AG-ACNP
Provider Business Mailing Address
First Line : 376 W 10TH AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43210-1280
Country : US
Telephone Number : 614-293-8305
Fax Number : 614-293-3124
Provider Business Practice Location Address
First Line : 376 W.10TH AVENUE
Second Line : 760 PRIOR HALL
City : COLUMBUS
State : OH
Zip : 43210-1238
Country : US
Telephone Number : 614-293-8305
Fax Number : 614-293-3124
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2018
Last Update Date : 07/25/2018

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