Provider Demographics
NPI:1902337595
Name:RIVAS, BRIANNA C (NP)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:C
Last Name:RIVAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6817 SOUTHPOINT PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6286
Mailing Address - Country:US
Mailing Address - Phone:904-330-1024
Mailing Address - Fax:
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 203
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6286
Practice Address - Country:US
Practice Address - Phone:904-330-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9348141363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner