Healthcare Provider Details

I. General information

NPI: 1417625187
Provider Name (Legal Business Name): STACY MARIE RIVERA RIVERA AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY MARIE TORRES AG-ACNP

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/13/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 VANDERBILT PARK DR
ASHEVILLE NC
28803-1700
US

IV. Provider business mailing address

7 VANDERBILT PARK DR
ASHEVILLE NC
28803-1700
US

V. Phone/Fax

Practice location:
  • Phone: 828-255-7776
  • Fax:
Mailing address:
  • Phone: 352-474-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11035492
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95011538
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95011538
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11035492
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5022525
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5022525
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: