MEDICARE: MR. YANDY ANGEL RODRIGUEZ GONZALEZ APRN, AGACNP-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	363L00000X	Nurse Practitioner	APRN11036367	FL

General Provider Information

NPI Number	:	1932922291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YANDY ANGEL RODRIGUEZ GONZALEZ APRN, AGACNP-BC

Provider Business Mailing Address
First Line	:	7777 DAVIE ROAD EXT STE 107B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2523
Country	:	US
Telephone Number	:	754-799-0088
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 DAVIE ROAD EXT STE 107B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2523
Country	:	US
Telephone Number	:	754-799-0088
Fax Number	:

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

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	02/27/2026

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