Provider Demographics
NPI:1184823015
Name:RIVERS, ANGELA YVONNE (LMT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:YVONNE
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 S HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-9396
Mailing Address - Country:US
Mailing Address - Phone:386-312-8309
Mailing Address - Fax:
Practice Address - Street 1:839 S HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-9396
Practice Address - Country:US
Practice Address - Phone:386-312-8309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA41062246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical