Healthcare Provider Details

I. General information

NPI: 1336731546
Provider Name (Legal Business Name): EDWIN RIVERA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 SE 3RD CT
OCALA FL
34471-0445
US

IV. Provider business mailing address

2980 SE 3RD CT
OCALA FL
34471-0445
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-4231
  • Fax: 352-622-0518
Mailing address:
  • Phone: 352-622-4231
  • Fax: 352-622-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: