Provider Demographics
NPI:1053296764
Name:RIVERA, ALEXIS (MSN, APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSN, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 N HABANA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7107
Mailing Address - Country:US
Mailing Address - Phone:813-875-9362
Mailing Address - Fax:813-876-7055
Practice Address - Street 1:4620 N HABANA AVE STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7107
Practice Address - Country:US
Practice Address - Phone:813-875-9362
Practice Address - Fax:813-876-7055
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11041455363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology