Provider Demographics
NPI:1265196125
Name:RIVERA LUGO, LUIS ANIBAL (FNP)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANIBAL
Last Name:RIVERA LUGO
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 1:2775 LAKE ALFRED RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-1432
Mailing Address - Country:US
Mailing Address - Phone:863-291-4590
Mailing Address - Fax:863-508-6503
Practice Address - Street 1:502 E HINSON AVE
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-5240
Practice Address - Country:US
Practice Address - Phone:863-438-7911
Practice Address - Fax:863-638-5035
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily