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NPI Code Detail

MEDICARE: INDIAN RIVER MEDICAL OFFICE PA

MEDICARE: INDIAN RIVER MEDICAL OFFICE PA
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
1363L00000XNurse Practitioner1189412FL

General Provider Information

NPI Number : 1467840710
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDIAN RIVER MEDICAL OFFICE PA
Provider Business Mailing Address
First Line : 3300 DAIRY RD
Second Line :
City : TITUSVILLE
State : FL
Zip : 32796-1512
Country : US
Telephone Number : 321-269-6530
Fax Number : 321-269-2334
Provider Business Practice Location Address
First Line : 3300 DAIRY RD
Second Line :
City : TITUSVILLE
State : FL
Zip : 32796-1512
Country : US
Telephone Number : 321-269-6530
Fax Number : 321-269-2334
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. SHERRY RILEY
Credential : ARNP
Telephone Number : 321-269-6530
Provider Enumeration Date : 01/08/2015
Last Update Date : 01/08/2015

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1215939509 — DR. ALUINO LAWRENCE OCHOA M.D.
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1245220557 — INDIAN RIVER MEDICAL OFFICE PA
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1467586388 — MRS. CHERYL M GARDNER ARNP
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1467769612 — MS. SHERRY LYNN RILEY ARNP
Practice Location Address:
3300 DAIRY RD
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1396172409 — MRS. JACKLYN ALEXIS XAVIER P.A-C
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Directions to “INDIAN RIVER MEDICAL OFFICE PA ” Practice Location

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