Provider Demographics
NPI:1588338198
Name:RODRIGUEZ TAMAYO, ELIDA MARINA II (LPN)
Entity type:Individual
Prefix:
First Name:ELIDA
Middle Name:MARINA
Last Name:RODRIGUEZ TAMAYO
Suffix:II
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 POST DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2673
Mailing Address - Country:US
Mailing Address - Phone:561-713-5811
Mailing Address - Fax:
Practice Address - Street 1:4413 POST DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2673
Practice Address - Country:US
Practice Address - Phone:561-713-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703123703164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse