MEDICARE: LUCIA RIBEIRO

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	3432217	NY

General Provider Information

NPI Number	:	1649766767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIA RIBEIRO

Provider Business Mailing Address
First Line	:	14 MOLLYS WAY
Second Line	:
City	:	SALT POINT
State	:	NY
Zip	:	12578-3109
Country	:	US
Telephone Number	:	941-276-0983
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 MOLLYS WAY
Second Line	:
City	:	SALT POINT
State	:	NY
Zip	:	12578-3109
Country	:	US
Telephone Number	:	941-276-0983
Fax Number	:

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

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	07/02/2018

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Directions to “ LUCIA RIBEIRO ” Practice Location

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