Healthcare Provider Details

I. General information

NPI: 1245066265
Provider Name (Legal Business Name): BLIVEN SZAKACSY ROMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 11/05/2026
Certification Date: 11/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13005 US HIGHWAY 301 S
RIVERVIEW FL
33578-7439
US

IV. Provider business mailing address

13005 US HIGHWAY 301 S
RIVERVIEW FL
33578-7439
US

V. Phone/Fax

Practice location:
  • Phone: 813-915-5291
  • Fax: 813-915-5293
Mailing address:
  • Phone: 813-915-5291
  • Fax: 813-915-5293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11035088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: