Provider Demographics
NPI:1134885999
Name:RIVERA, MELINDA (MSN , NP-C)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSN , NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11340 ALAMEDA SANDRA DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6300
Mailing Address - Country:US
Mailing Address - Phone:850-723-1601
Mailing Address - Fax:
Practice Address - Street 1:201 N LAKEMONT AVE STE 2100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3208
Practice Address - Country:US
Practice Address - Phone:321-444-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014954363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11014954OtherAPRN LICENSE