Provider Demographics
NPI:1528773199
Name:MCCOOK, RODNEY L
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:L
Last Name:MCCOOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MYRTLE BREEZES CT
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-6548
Mailing Address - Country:US
Mailing Address - Phone:352-348-6731
Mailing Address - Fax:
Practice Address - Street 1:1101 MYRTLE BREEZES CT
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-6548
Practice Address - Country:US
Practice Address - Phone:352-348-6731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3523486731Medicaid