Provider Demographics
NPI:1043858913
Name:RODRIGUEZ, SANDRA (RN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S OLD ORCHARD LN STE 126
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4374
Mailing Address - Country:US
Mailing Address - Phone:972-436-7962
Mailing Address - Fax:972-420-0085
Practice Address - Street 1:502 S OLD ORCHARD LN STE 126
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4374
Practice Address - Country:US
Practice Address - Phone:972-436-7962
Practice Address - Fax:972-420-0085
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX723656363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics