MEDICARE: JESSICA RODRIGUEZ ARNP

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	363L00000X	Nurse Practitioner	APRN11013304	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NX369	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	15154379	OTHER		CAQH
3	1407805021	OTHER		GROUP NPI ASSOCIATION

General Provider Information

NPI Number	:	1477127827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RODRIGUEZ ARNP

Provider Business Mailing Address
First Line	:	3654 SW 30TH AVE
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-3700
Country	:	US
Telephone Number	:	772-210-7555
Fax Number	:	772-266-8207

Provider Business Practice Location Address
First Line	:	3654 SW 30TH AVE
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-3700
Country	:	US
Telephone Number	:	772-210-7555
Fax Number	:	772-266-8207

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

Provider Enumeration Date	:	05/19/2021
Last Update Date	:	09/06/2023

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