Provider Demographics
NPI:1134505472
Name:RIZA, CARMEN DANIELA (ARNP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:DANIELA
Last Name:RIZA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11761 BEACH BLVD
Mailing Address - Street 2:STE 8
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-6615
Mailing Address - Country:US
Mailing Address - Phone:904-642-3304
Mailing Address - Fax:904-642-8375
Practice Address - Street 1:11761 BEACH BLVD
Practice Address - Street 2:STE 8
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6615
Practice Address - Country:US
Practice Address - Phone:904-642-3304
Practice Address - Fax:904-642-8375
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3386182363LA2200X
FLARNP3386182363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology