Provider Demographics
NPI:1699499467
Name:RODRIGUEZ, MICHAEL JOSE (APRN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:41 RIVERCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-5025
Mailing Address - Country:US
Mailing Address - Phone:203-809-4504
Mailing Address - Fax:
Practice Address - Street 1:175 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4357
Practice Address - Country:US
Practice Address - Phone:203-789-3363
Practice Address - Fax:203-789-4081
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT140147163WC0200X
CT11260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine