MEDICARE: KRYSTAL 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	APRN11008865	FL
2	363LF0000X	Family Nurse Practitioner	860281	NV
3	163WP2201X	Ambulatory Care Registered Nurse	RN9352782	FL

General Provider Information

NPI Number	:	1174153498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL RIVERA

Provider Business Mailing Address
First Line	:	873 COTTONWOOD HILL PL
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-5628
Country	:	US
Telephone Number	:	786-300-9288
Fax Number	:

Provider Business Practice Location Address
First Line	:	873 COTTONWOOD HILL PL
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-5628
Country	:	US
Telephone Number	:	786-300-9288
Fax Number	:

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

Provider Enumeration Date	:	01/26/2020
Last Update Date	:	04/15/2026

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Directions to “ KRYSTAL RIVERA ” Practice Location

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