Provider Demographics
NPI:1326239070
Name:RIVERA, JEFFREY (RN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 N RENNES CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3863
Mailing Address - Country:US
Mailing Address - Phone:321-624-9949
Mailing Address - Fax:407-264-6742
Practice Address - Street 1:709 N RENNES CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3863
Practice Address - Country:US
Practice Address - Phone:321-624-9949
Practice Address - Fax:407-264-6742
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9172784163WA2000X, 163WC1500X, 163WI0500X, 163WW0000X, 163WH0200X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound Care