Healthcare Provider Details

I. General information

NPI: 1295543288
Provider Name (Legal Business Name): CRISTIAN DAVID RIVERA MORALES I PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CRISTIAN DAVID RIVERA PMHNP-BC

II. Dates (important events)

Enumeration Date: 12/21/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14243 HOLLY POND CT
ORLANDO FL
32824-7833
US

IV. Provider business mailing address

14243 HOLLY POND CT
ORLANDO FL
32824-7833
US

V. Phone/Fax

Practice location:
  • Phone: 407-308-5524
  • Fax:
Mailing address:
  • Phone: 407-308-5524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11036841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: