Provider Demographics
NPI:1386155505
Name:RODRIGUEZ, ALICIA MERCEDES
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MERCEDES
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 10TH AVE N STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6609
Mailing Address - Country:US
Mailing Address - Phone:561-296-2220
Mailing Address - Fax:561-296-2221
Practice Address - Street 1:2290 10TH AVE N STE 201
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6609
Practice Address - Country:US
Practice Address - Phone:561-296-2220
Practice Address - Fax:561-296-2221
Is Sole Proprietor?:No
Enumeration Date:2017-10-15
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9428553363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care