Healthcare Provider Details

I. General information

NPI: 1265889794
Provider Name (Legal Business Name): NIRZA VICTORIA SISALEMA RIVAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 S LE JEUNE RD
CORAL GABLES FL
33146-2231
US

IV. Provider business mailing address

12271 SW 143RD LN
MIAMI FL
33186-6021
US

V. Phone/Fax

Practice location:
  • Phone: 305-239-5585
  • Fax:
Mailing address:
  • Phone: 941-284-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11019562
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number15-132
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: