Provider Demographics
NPI:1912590076
Name:RODRIGUEZ, AMANDA RAE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 W BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-5270
Mailing Address - Country:US
Mailing Address - Phone:602-690-2713
Mailing Address - Fax:
Practice Address - Street 1:1110 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6163
Practice Address - Country:US
Practice Address - Phone:480-855-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ252669363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner