MEDICARE: REBECCA M RIVERA APRN LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1578175360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBECCA M RIVERA APRN LLC

Provider Business Mailing Address
First Line	:	2724 NW 124TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-8014
Country	:	US
Telephone Number	:	965-860-9992
Fax Number	:

Provider Business Practice Location Address
First Line	:	2631 E OAKLAND PARK BLVD STE 110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1607
Country	:	US
Telephone Number	:	954-514-7306
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	REBECCA MARIA RIVERA
Credential	:	APRN
Telephone Number	:	954-850-9992

Provider Enumeration Date	:	08/21/2020
Last Update Date	:	08/21/2020

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