Provider Demographics
NPI:1548675051
Name:RIVERS, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S ORANGE BLOSSOM TRL STE 269
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3197
Mailing Address - Country:US
Mailing Address - Phone:407-674-8988
Mailing Address - Fax:407-674-8992
Practice Address - Street 1:750 S ORANGE BLOSSOM TRL STE 227
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3195
Practice Address - Country:US
Practice Address - Phone:407-674-8988
Practice Address - Fax:407-674-8992
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL105339100253Z00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105339100Medicaid
FL106038800Medicaid
FL003575300Medicaid