MEDICARE: LUIS ANIBAL RIVERA LUGO FNP

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	11016191	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265196125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS ANIBAL RIVERA LUGO FNP

Provider Business Mailing Address
First Line	:	2775 LAKE ALFRED RD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-1432
Country	:	US
Telephone Number	:	863-291-4590
Fax Number	:	863-508-6503

Provider Business Practice Location Address
First Line	:	502 E HINSON AVE
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-5240
Country	:	US
Telephone Number	:	863-438-7911
Fax Number	:	863-638-5035

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

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	02/22/2024

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