Provider Demographics
NPI:1154048486
Name:RODRIGUEZ, JORGE JAVIER (APRN)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:JAVIER
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7530 W 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3408
Mailing Address - Country:US
Mailing Address - Phone:305-301-6516
Mailing Address - Fax:
Practice Address - Street 1:4100 NW 9TH ST STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3678
Practice Address - Country:US
Practice Address - Phone:305-301-6516
Practice Address - Fax:305-642-0530
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily