Provider Demographics
NPI:1578175360
Name:REBECCA M RIVERA APRN LLC
Entity Type:Organization
Organization Name:REBECCA M RIVERA APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-850-9992
Mailing Address - Street 1:2724 NW 124TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-8014
Mailing Address - Country:US
Mailing Address - Phone:965-860-9992
Mailing Address - Fax:
Practice Address - Street 1:2631 E OAKLAND PARK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1607
Practice Address - Country:US
Practice Address - Phone:954-514-7306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care