Provider Demographics
NPI:1861554677
Name:RIVERA, JANICE B (PA-C)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:B
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9145 NARCOOSSEE RD
Mailing Address - Street 2:SUITE A200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-5768
Mailing Address - Country:US
Mailing Address - Phone:407-412-5030
Mailing Address - Fax:407-601-7946
Practice Address - Street 1:9145 NARCOOSSEE RD
Practice Address - Street 2:SUITE A200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-5768
Practice Address - Country:US
Practice Address - Phone:407-412-5030
Practice Address - Fax:407-601-7946
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107340363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIC434ZMedicare UPIN
Q42740Medicare UPIN