Provider Demographics
NPI:1306321955
Name:RODRIGUEZ, MERLYN (APRN)
Entity type:Individual
Prefix:
First Name:MERLYN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 BLUE LAGOON DR STE 365
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-7010
Mailing Address - Country:US
Mailing Address - Phone:786-322-7333
Mailing Address - Fax:
Practice Address - Street 1:743 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2404
Practice Address - Country:US
Practice Address - Phone:305-957-0017
Practice Address - Fax:786-629-3922
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-29
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9366871363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105257600Medicaid
FLAPRN11000788OtherAPRN LICENSE