Individual provider · NPI-1

Paul Gagarin Colmenares Rodriguez, FNP

Nurse Practitioner, Family · Orlando, FL

NPI number1447800164
StatusActive
Last updated in NPPESOct 1, 2023

Details

NPI
1447800164
Entity type
Individual (NPI-1)
Name
Paul Gagarin Colmenares Rodriguez
Credential
FNP
Sex
Male
Sole proprietor
Yes
Enumeration date
Sep 14, 2019
Certification date
Oct 1, 2023
Last updated
Oct 1, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, FamilyF09231243FLYes
163WR0006X Registered Nurse, Registered Nurse First AssistantRN-9529942FL
246ZC0007X Specialist/Technologist, Other, Surgical Assistant16-743AZ

Practice location

10090 Madison Banks St
Orlando, FL 32827-6940

Phone 407-715-1683

Mailing address

10090 Madison Banks St
Orlando, FL 32827-6940

Phone 407-715-1683

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