Provider Demographics
NPI:1801804224
Name:RIVERA, MARIA ANTONIA (ARNP CNM)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANTONIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:ARNP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 YELLOWKNIFE CIR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598
Mailing Address - Country:US
Mailing Address - Phone:813-633-0122
Mailing Address - Fax:
Practice Address - Street 1:2814 14TH AVE SE
Practice Address - Street 2:RUSKIN HEALTH CENTER
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570
Practice Address - Country:US
Practice Address - Phone:813-349-7800
Practice Address - Fax:813-349-7832
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1065452363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E67882Medicare ID - Type Unspecified
S01307Medicare UPIN