Provider Demographics
NPI:1154121044
Name:RODRIGUEZ, JADE NICOLE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:NICOLE
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 ESSINGTON RD STE 146
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1664
Mailing Address - Country:US
Mailing Address - Phone:708-336-0294
Mailing Address - Fax:
Practice Address - Street 1:1016 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1715
Practice Address - Country:US
Practice Address - Phone:847-506-9767
Practice Address - Fax:847-507-9769
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.473064163W00000X
IL209.031877363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse