Provider Demographics
NPI:1508214966
Name:FORNIER, RIZA
Entity Type:Individual
Prefix:
First Name:RIZA
Middle Name:
Last Name:FORNIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 KATIE HILL WAY
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6234
Mailing Address - Country:US
Mailing Address - Phone:321-315-9709
Mailing Address - Fax:
Practice Address - Street 1:1925 KATIE HILL WAY
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6234
Practice Address - Country:US
Practice Address - Phone:321-315-9709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9199911163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse