Provider Demographics
NPI:1346712049
Name:MONTALVAN RODRIGUEZ, MANUEL ALEJANDRO (APRN)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:ALEJANDRO
Last Name:MONTALVAN RODRIGUEZ
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:A
Other - Last Name:MONTALVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1023 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-5107
Mailing Address - Country:US
Mailing Address - Phone:863-201-7329
Mailing Address - Fax:863-201-7251
Practice Address - Street 1:1023 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-5107
Practice Address - Country:US
Practice Address - Phone:786-383-1818
Practice Address - Fax:770-691-5064
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily