Provider Demographics
NPI:1104253145
Name:RODGERS, FATIMA
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 S ORANGE AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3067
Mailing Address - Country:US
Mailing Address - Phone:407-900-5181
Mailing Address - Fax:407-459-8173
Practice Address - Street 1:5205 S ORANGE AVE STE 206
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-3067
Practice Address - Country:US
Practice Address - Phone:407-900-5181
Practice Address - Fax:407-459-8173
Is Sole Proprietor?:No
Enumeration Date:2013-10-06
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator