Provider Demographics
NPI:1992480156
Name:RODRIGUEZ, KENDRA ANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:ANNE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21450 COUNTY ROAD 561
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-6863
Mailing Address - Country:US
Mailing Address - Phone:407-600-8937
Mailing Address - Fax:
Practice Address - Street 1:21450 COUNTY ROAD 561
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34715-6863
Practice Address - Country:US
Practice Address - Phone:407-600-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9389903163W00000X
FL11026997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse