Healthcare Provider Details

I. General information

NPI: 1982188421
Provider Name (Legal Business Name): SHERRY RIVERA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 GATE PKWY BLDG 100
JACKSONVILLE FL
32256-0830
US

IV. Provider business mailing address

PO BOX 740019
ATLANTA GA
30374-0019
US

V. Phone/Fax

Practice location:
  • Phone: 904-281-1915
  • Fax: 904-281-1119
Mailing address:
  • Phone: 833-804-1695
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902807
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025032067
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number902807
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: