Healthcare Provider Details

I. General information

NPI: 1912418377
Provider Name (Legal Business Name): REBEKA ANN RIVERA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 SE OSCEOLA ST STE 100
STUART FL
34994-2322
US

IV. Provider business mailing address

PO BOX 3130
OCALA FL
34478-3130
US

V. Phone/Fax

Practice location:
  • Phone: 772-419-2379
  • Fax: 772-419-2377
Mailing address:
  • Phone: 352-369-0286
  • Fax: 352-867-5076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9234118
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9234118
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9234118
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: