Provider Demographics
NPI:1457143398
Name:RODRIGUEZ, JENNY M (RN, LMT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7705 LAKE GANDY CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-2881
Mailing Address - Country:US
Mailing Address - Phone:407-242-4020
Mailing Address - Fax:407-242-4020
Practice Address - Street 1:7705 LAKE GANDY CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-2881
Practice Address - Country:US
Practice Address - Phone:407-242-4020
Practice Address - Fax:407-242-4020
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA102246225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist