Healthcare Provider Details

I. General information

NPI: 1942185079
Provider Name (Legal Business Name): ANTHONY RIVERON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7814 N DALE MABRY HWY
TAMPA FL
33614-3220
US

IV. Provider business mailing address

5940 BIRCHWOOD DR
TAMPA FL
33625-5670
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-5300
  • Fax:
Mailing address:
  • Phone: 813-445-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: