Provider Demographics
NPI:1518281310
Name:RIVERA, NADIA AMANDA (MD, MPH)
Entity Type:Individual
Prefix:MRS
First Name:NADIA
Middle Name:AMANDA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:407-889-7742
Practice Address - Street 1:202 N PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4148
Practice Address - Country:US
Practice Address - Phone:407-889-4711
Practice Address - Fax:407-889-7742
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL148FGOtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
FLME106656OtherMEDICAL LICENSE
FL004260400Medicaid
FL1917650OtherDEA
FL1917650OtherDEA
FL004232400OtherMEDICAID GROUP NUMBER
FL004260400Medicaid