MEDICARE: AFRODICIO R HERNANDEZ RIVELA ARNP

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	363LP2300X	Primary Care Nurse Practitioner	11019085	FL

General Provider Information

NPI Number	:	1235872953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFRODICIO R HERNANDEZ RIVELA ARNP

Provider Business Mailing Address
First Line	:	7512 CLEARVIEW DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2930
Country	:	US
Telephone Number	:	813-403-8521
Fax Number	:

Provider Business Practice Location Address
First Line	:	7512 CLEARVIEW DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2930
Country	:	US
Telephone Number	:	813-403-8521
Fax Number	:

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

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	02/23/2023

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