Provider Demographics
NPI:1780866798
Name:RIVERA, SAMANTHA BRISKIE
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:BRISKIE
Last Name:RIVERA
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:PO BOX 9177
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120
Mailing Address - Country:US
Mailing Address - Phone:386-255-5569
Mailing Address - Fax:386-255-5277
Practice Address - Street 1:240 N FREDERICK
Practice Address - Street 2:SUITE A
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-255-5569
Practice Address - Fax:386-255-5277
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator