Provider Demographics
NPI:1194791954
Name:RODRIGUEZ, MINERVA (ARNP WHNP C)
Entity type:Individual
Prefix:MRS
First Name:MINERVA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:ARNP WHNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:SUITE 1 D03
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:803-528-5728
Mailing Address - Fax:912-727-4465
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:SUITE 1 D03
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:803-528-5728
Practice Address - Fax:912-727-4465
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002484363LW0102X, 363LX0001X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care