Basic Information
Provider Information | |||||||||
NPI: | 1255789194 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RODRIGUEZ-CAPOTE | ||||||||
FirstName: | INES | ||||||||
MiddleName: | JACQUELINE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ARNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 14690 SPRING HILL DR STE 101 | ||||||||
Address2: |   | ||||||||
City: | SPRING HILL | ||||||||
State: | FL | ||||||||
PostalCode: | 346098102 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3527990046 | ||||||||
FaxNumber: | 3526062857 | ||||||||
Practice Location | |||||||||
Address1: | 5350 SPRING HILL DR | ||||||||
Address2: |   | ||||||||
City: | SPRING HILL | ||||||||
State: | FL | ||||||||
PostalCode: | 34606 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3526888116 | ||||||||
FaxNumber: | 3526869477 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/01/2016 | ||||||||
LastUpdateDate: | 08/08/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9319238 | FL | N |   | Nursing Service Providers | Registered Nurse |   | 364SF0001X | ARNP 9319238 | FL | N |   | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health | 208M00000X | ARNP9319238 | FL | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 017778300 | 05 | FL |   | MEDICAID | B8T09 | 01 |   | BCBS | OTHER |