Provider Demographics
NPI:1679978621
Name:RODRIGUEZ, STEPHANIE PAQUET
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PAQUET
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MAVERICK CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-1381
Mailing Address - Country:US
Mailing Address - Phone:305-283-8113
Mailing Address - Fax:
Practice Address - Street 1:7300 SW 62ND PL
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4806
Practice Address - Country:US
Practice Address - Phone:305-283-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-01
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9274503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily