MEDICARE: SANDRA ELIZABETH RODRIGUEZ

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	1139921	TX

General Provider Information

NPI Number	:	1992577142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA ELIZABETH RODRIGUEZ

Provider Business Mailing Address
First Line	:	3143 PRONGHORN PATH
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-1284
Country	:	US
Telephone Number	:	325-374-6573
Fax Number	:

Provider Business Practice Location Address
First Line	:	2029 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-3812
Country	:	US
Telephone Number	:	325-658-5339
Fax Number	:

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

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	10/23/2023

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