Provider Demographics
NPI:1659069979
Name:RIVERA BURGOS, ALBA VANESSA (APRN)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:VANESSA
Last Name:RIVERA BURGOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 W HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4055
Mailing Address - Country:US
Mailing Address - Phone:813-467-4265
Mailing Address - Fax:
Practice Address - Street 1:3617 W HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4055
Practice Address - Country:US
Practice Address - Phone:813-467-4265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily