MEDICARE: ANGEL RIVERS 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP11140	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER	AZ	NONE

General Provider Information

NPI Number	:	1730605890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL RIVERS FNP-C

Provider Business Mailing Address
First Line	:	4601 E FORT LOWELL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1183
Country	:	US
Telephone Number	:	520-396-4413
Fax Number	:	520-396-4764

Provider Business Practice Location Address
First Line	:	4601 E FORT LOWELL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1183
Country	:	US
Telephone Number	:	520-396-4413
Fax Number	:	520-396-4764

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

Provider Enumeration Date	:	08/20/2017
Last Update Date	:	11/25/2025

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