Provider Demographics
NPI:1003622069
Name:RIVAS TOLL, JOSE FULGENCIO (FNP)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:FULGENCIO
Last Name:RIVAS TOLL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 180TH DR APT 409
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2729
Mailing Address - Country:US
Mailing Address - Phone:786-312-2951
Mailing Address - Fax:
Practice Address - Street 1:201 180TH DR APT 409
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2729
Practice Address - Country:US
Practice Address - Phone:786-312-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF11240763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily