Healthcare Provider Details

I. General information

NPI: 1376315317
Provider Name (Legal Business Name): YESENIA MARIE RIVERA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 VINCENT ST. SPACE BASE DELTA 1
PETERSON SPACE FORCE BASE CO
80914
US

IV. Provider business mailing address

559 VINCENT ST. SPACE BASE DELTA 1
PETERSON SPACE FORCE BASE CO
80914
US

V. Phone/Fax

Practice location:
  • Phone: 850-737-9290
  • Fax:
Mailing address:
  • Phone: 850-737-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-148822
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: