Provider Demographics
NPI:1154832574
Name:RIVAS, RAQUEL IVET (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:IVET
Last Name:RIVAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:IVET
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:4110 N 108TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5772
Mailing Address - Country:US
Mailing Address - Phone:623-772-6999
Mailing Address - Fax:623-772-6444
Practice Address - Street 1:4110 N 108TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5772
Practice Address - Country:US
Practice Address - Phone:623-772-6999
Practice Address - Fax:623-772-6444
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily