NPIMap

Individual provider Active NPI

Nicole Rodriguez, NURSE PRACTITIONER

  • Nurse Practitioner
  • Lake Mary, FL
National Provider Identifier
1609346378
Registry record updated Mar 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9399156 Issued in FL
Practice address
4106 W Lake Mary Blvd
Lake Mary, FL 32746-3315
Phone
(407) 333-2503
NPI assigned
Nov 26, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9399156 FL Primary

Addresses

Primary practice location

4106 W Lake Mary Blvd
Lake Mary, FL 32746-3315

Mailing address

4106 W Lake Mary Blvd
Lake Mary, FL 32746-3315
Phone (407) 333-2503

Other practice location 1

2836 Lightwood St
Deltona, FL 32738-9185
Phone (386) 299-9502

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190423000346 FL Practitioner - Nurse Practitioner 8820330806 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians
Florida Internal Medicine PAGroup PAC ID 8022100080, 2 clinicians

Practice addresses (Care Compare)

1200 Lexington Green LN
Sanford, FL 32771-1013

4106 W Lake Mary Blvd
Suite 301
Lake Mary, FL 32746-3344
Phone (407) 333-2503

Hospital & facility affiliations

  • Kindred at Home Home health agency, Lake Mary, FL, CCN 107739
  • Adventhealth Home Health Home health agency, Altamonte Springs, FL, CCN 107211
  • Concierge Home Care Home health agency, Heathrow, FL, CCN 687134
  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007
  • Orlando Health Hospital, Orlando, FL, CCN 100006
  • Adventhealth Fish Memorial Hospital, Orange City, FL, CCN 100072
  • Adventhealth Waterman Hospital, Tavares, FL, CCN 100057
  • Adventhealth Deland Hospital, Deland, FL, CCN 100045

Merit-based Incentive Payment System (MIPS)

Final score
99.1 of 100Reported as individual
Quality
100
Promoting interoperability
97
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9399156FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Internal Medicine PA CurrentSince Feb 1, 2019 Accepting new patients

Locations

4106 W Lake Mary Blvd
Ste 301
Lake Mary, FL 32746
Phone (407) 333-2503

Interoperability endpoints

  • Direct secure messaging: nicole.rodriguez.1@24880.direct.athenahealth.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1609346378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463315",
            "telephone_number": "407-333-2503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463315",
            "telephone_number": "407-333-2503"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2836 Lightwood St",
            "address_purpose": "LOCATION",
            "city": "Deltona",
            "state": "FL",
            "postal_code": "327389185",
            "country_code": "US",
            "telephone_number": "386-299-9502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "NICOLE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-26",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "9399156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.