Basic Information
Provider Information
NPI: 1508529322
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CABRAL-RODRIGUEZ
FirstName: BETH
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
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OtherLastName:  
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Mailing Information
Address1: 38135 MARKET SQ
Address2:  
City: ZEPHYRHILLS
State: FL
PostalCode: 335427505
CountryCode: US
TelephoneNumber: 3525670188
FaxNumber: 8133555101
Practice Location
Address1: 2100 VIA BELLA BLVD STE 201
Address2:  
City: LAND O LAKES
State: FL
PostalCode: 346395429
CountryCode: US
TelephoneNumber: 8135284900
FaxNumber: 8133555064
Other Information
ProviderEnumerationDate: 10/19/2021
LastUpdateDate: 11/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAPRN11015394FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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