Provider Demographics
NPI:1174061618
Name:MATTEI RIVERA, MITZY (APRN)
Entity type:Individual
Prefix:MRS
First Name:MITZY
Middle Name:
Last Name:MATTEI RIVERA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:MITZY
Other - Middle Name:
Other - Last Name:MATTEI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:306 S 10TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-5602
Mailing Address - Country:US
Mailing Address - Phone:863-438-2038
Mailing Address - Fax:321-900-4408
Practice Address - Street 1:306 S 10TH ST STE 320
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-5602
Practice Address - Country:US
Practice Address - Phone:863-438-2038
Practice Address - Fax:321-900-4408
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-04
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9351665363LF0000X
FL9351665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101953000Medicaid