Provider Demographics
NPI:1588202428
Name:ROBLES RIVERA, SANDRA IVELISSE (FNP/RNFA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:IVELISSE
Last Name:ROBLES RIVERA
Suffix:
Gender:F
Credentials:FNP/RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18983 SW 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7169
Mailing Address - Country:US
Mailing Address - Phone:305-846-0340
Mailing Address - Fax:
Practice Address - Street 1:18983 SW 135TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-7169
Practice Address - Country:US
Practice Address - Phone:305-846-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF11190524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily