Provider Demographics
NPI:1508625435
Name:RIGAL LEYVA, IVAN (APRN)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:
Last Name:RIGAL LEYVA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 LETO LAKES BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3723
Mailing Address - Country:US
Mailing Address - Phone:229-251-7650
Mailing Address - Fax:
Practice Address - Street 1:4430 LETO LAKES BLVD APT 206
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3723
Practice Address - Country:US
Practice Address - Phone:229-251-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily