Basic Information
| Provider Information | |||||||||
| NPI: | 1912418377 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | REBEKA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3130 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344783130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523690286 | ||||||||
| FaxNumber: | 3528675076 | ||||||||
| Practice Location | |||||||||
| Address1: | 524 SE OSCEOLA ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349942322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724192379 | ||||||||
| FaxNumber: | 7724192377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9234118 | FL | N | Nursing Service Providers | Registered Nurse | 363L00000X | ARNP9234118 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | ARNP9234118 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | ARNP9234118 | 01 | FL | STATE MEDICAL LICENSE | OTHER |