Provider Demographics
NPI:1518557271
Name:RIVERT, BRENISE
Entity Type:Individual
Prefix:
First Name:BRENISE
Middle Name:
Last Name:RIVERT
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 1:2510 SW COOPER LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5010
Mailing Address - Country:US
Mailing Address - Phone:772-342-8133
Mailing Address - Fax:
Practice Address - Street 1:2510 SW COOPER LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5010
Practice Address - Country:US
Practice Address - Phone:772-342-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA26675376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide