=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487218608
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NELIDA RIVERA TOLEDO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2019
-----------------------------------------------------
Last Update Date | 04/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 KINGSLEY AVE
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32073-5148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-639-8628
-----------------------------------------------------
Fax | 904-639-8593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8655 DERRY DR
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32244-7121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-505-4602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11000904
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------