Basic Information
| Provider Information | |||||||||
| NPI: | 1952848335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ-BORASZ | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3737 SOUTHERN BLVD STE 4200 | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454290135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372941489 | ||||||||
| FaxNumber: | 9372947999 | ||||||||
| Practice Location | |||||||||
| Address1: | 3737 SOUTHERN BLVD STE 4200 | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454290135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372941489 | ||||||||
| FaxNumber: | 9372947999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2017 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.020229 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.