MEDICARE: ANGIE RIVERA FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1004538	TX

General Provider Information

NPI Number	:	1235730623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGIE RIVERA FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 99213
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76199-0213
Country	:	US
Telephone Number	:	682-885-1860
Fax Number	:	682-885-1396

Provider Business Practice Location Address
First Line	:	10601 N RIVERSIDE DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76244-2118
Country	:	US
Telephone Number	:	817-347-2600
Fax Number	:	817-347-2670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	04/19/2021

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Directions to “ ANGIE RIVERA FNP-C” Practice Location

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