Provider Demographics
NPI:1134805534
Name:NOVA'S INNOVATED URGENT CARE, LLC.
Entity type:Organization
Organization Name:NOVA'S INNOVATED URGENT CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:FREDERIED
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-693-2819
Mailing Address - Street 1:4417 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6724
Mailing Address - Country:US
Mailing Address - Phone:407-693-2819
Mailing Address - Fax:407-264-6936
Practice Address - Street 1:737 SOUTH SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807
Practice Address - Country:US
Practice Address - Phone:407-693-2819
Practice Address - Fax:407-264-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty