Provider Demographics
NPI:1518550854
Name:RIVERA, KEVIN OMAR SR (RN)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:OMAR
Last Name:RIVERA
Suffix:SR
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 1:5242 BRACKS LANDING DR # 5242
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8064
Mailing Address - Country:US
Mailing Address - Phone:787-383-1437
Mailing Address - Fax:
Practice Address - Street 1:5242 BRACKS LANDING DR # 5242
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8064
Practice Address - Country:US
Practice Address - Phone:787-383-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9458076163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator