Healthcare Provider Details

I. General information

NPI: 1104758549
Provider Name (Legal Business Name): WENDY ANGELINE RIVERA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 LAGOS DE CAMPO BLVD APT 208
TAMARAC FL
33321-8503
US

IV. Provider business mailing address

8380 LAGOS DE CAMPO BLVD APT 208
TAMARAC FL
33321-8503
US

V. Phone/Fax

Practice location:
  • Phone: 954-501-7724
  • Fax:
Mailing address:
  • Phone: 954-501-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN1001851
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: