Provider Demographics
NPI:1518005107
Name:RIVERA, HENRY R JR (ACNP, AOCNP)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:R
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:ACNP, AOCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11626 NEWELL DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-1541
Mailing Address - Country:US
Mailing Address - Phone:813-969-0104
Mailing Address - Fax:
Practice Address - Street 1:11626 NEWELL DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1541
Practice Address - Country:US
Practice Address - Phone:813-969-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9177520363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner