MEDICARE: ALEXANDRA DAMIRKASAN RIVERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11002937	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033761523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA DAMIRKASAN RIVERA

Provider Business Mailing Address
First Line	:	1885 DARTMOUTH DR
Second Line	:
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-6568
Country	:	US
Telephone Number	:	786-473-3158
Fax Number	:

Provider Business Practice Location Address
First Line	:	6488 103RD ST STE A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7161
Country	:	US
Telephone Number	:	904-450-8881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	04/12/2024

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