=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942952742
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRUCITA MARIE RIOSECO-MARTINEZ MSN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2022
-----------------------------------------------------
Last Update Date | 03/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6148 PARADISE POINT DR
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-2643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-218-5605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6148 PARADISE POINT DR
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-2643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-218-5605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 2846032
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364SP0809X
-----------------------------------------------------
Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | RN2846032
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 364SC2300X
-----------------------------------------------------
Taxonomy Name | Chronic Care Clinical Nurse Specialist
-----------------------------------------------------
License Number | RN2846032
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------