Provider Demographics
NPI:1962095133
Name:RODRIGUEZ, MARISSA M (NP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:M
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3251 NORTH STATE ROAD 7
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7063
Mailing Address - Country:US
Mailing Address - Phone:301-545-1430
Mailing Address - Fax:855-581-8052
Practice Address - Street 1:3251 NORTH STATE ROAD 7
Practice Address - Street 2:SUITE 200
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063
Practice Address - Country:US
Practice Address - Phone:954-247-6200
Practice Address - Fax:954-532-4632
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346936363LF0000X
FLAPRN11015926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily