Individual provider Active NPI

Kaitlin Rodriguez, APN

  • Primary Care Nurse Practitioner
  • Lakewood, NJ
National Provider Identifier
1851790992
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
9444701 Issued in FL
Practice address
101 2ND St
Lakewood, NJ 08701-3324
Phone
(732) 363-6655
Fax
(732) 901-0277
NPI assigned
Aug 14, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 26NR14432100 NJ
Registered Nurse 163W00000X 9444701 FL
Pediatric Nurse Practitioner 363LP0200X 26NJ00484000 NJ
Pediatric Nurse Practitioner 363LP0200X 9444701 FL
Primary Care Nurse Practitioner 363LP2300X 26NJ00484000 NJ
Primary Care Nurse Practitioner 363LP2300X AC002942 MD
Primary Care Nurse Practitioner 363LP2300X 9444701 FL Primary

Addresses

Primary practice location

101 2ND St
Lakewood, NJ 08701-3324

Mailing address

101 2ND St
Lakewood, NJ 08701-3324
Phone (732) 363-6655

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140930001436 NJ Practitioner - Nurse Practitioner 3173743911 Reassigns benefits to 1 organization
I20230408000103 FL Practitioner - Nurse Practitioner 3173743911

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26NR14432100NJMDRegistered Nurse
26NJ00484000NJMDPediatric Nurse Practitioner
9444701FLMDPrimary Care Nurse Practitioner
AC002942MDMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ocean Health Initiatives Inc Current Accepting new patients
Ocean Health Initiatives, Inc. CurrentSince Sep 2, 2014 Accepting new patients
Ocean Health Initiatives, Inc CurrentSince Sep 2, 2014 Accepting new patients

Locations

101 2nd St
Lakewood, NJ 08701
Phone (732) 886-4809

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589155200000",
    "number": "1851790992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 2ND ST",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013324",
            "telephone_number": "732-363-6655",
            "fax_number": "732-901-0277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 2ND ST",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013324",
            "telephone_number": "732-363-6655",
            "fax_number": "732-901-0277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "KAITLIN",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-14",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NR14432100",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "9444701",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NJ",
            "license": "26NJ00484000",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "9444701",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NJ",
            "license": "26NJ00484000",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MD",
            "license": "AC002942",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "9444701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

Verify at the official NPI Registry.