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General NPI Number Information
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NPI Number | 1679342810
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Entity Type | Individual
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Provider Name | TIERRA RIVERA
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Gender | Female
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Dates
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Enumeration Date | 12/29/2023
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 3086 WHISPER LAKE LN
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City | WINTER PARK
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State | FL
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Zip | 32792-8078
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Country | US
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Telephone | 407-335-2374
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Fax |
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Provider Business Mailing Address
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Address Line | 3086 WHISPER LAKE LN APT B
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City | WINTER PARK
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State | FL
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Zip | 32792-8026
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11025246
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License Number State | FL
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