Provider Demographics
NPI:1871254011
Name:RODZ, JEFF (RN)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:RODZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 BENTLEY DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-5202
Mailing Address - Country:US
Mailing Address - Phone:415-506-9052
Mailing Address - Fax:
Practice Address - Street 1:3104 E CAMELBACK RD # 2597
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4502
Practice Address - Country:US
Practice Address - Phone:415-506-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-09
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ318042367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered