Healthcare Provider Details

I. General information

NPI: 1417408311
Provider Name (Legal Business Name): JANET OLMEDA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12271 US HIGHWAY 301 N
PARRISH FL
34219-8410
US

IV. Provider business mailing address

101 RIVERFRONT BLVD STE 710
BRADENTON FL
34205-8812
US

V. Phone/Fax

Practice location:
  • Phone: 941-776-4050
  • Fax:
Mailing address:
  • Phone: 941-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63740
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109831
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: