Provider Demographics
NPI:1194169540
Name:RODRIGUEZ, MARC (NP-C)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2492 CENTERGATE DR APT 208
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7221
Mailing Address - Country:US
Mailing Address - Phone:954-383-1961
Mailing Address - Fax:888-920-1119
Practice Address - Street 1:2492 CENTERGATE DR APT 208
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7221
Practice Address - Country:US
Practice Address - Phone:954-383-1961
Practice Address - Fax:888-920-1119
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-28
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9281856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily