Provider Demographics
NPI:1265889794
Name:SISALEMA RIVAS, NIRZA VICTORIA (ARNP)
Entity type:Individual
Prefix:
First Name:NIRZA
Middle Name:VICTORIA
Last Name:SISALEMA RIVAS
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12271 SW 143RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6021
Mailing Address - Country:US
Mailing Address - Phone:941-284-9301
Mailing Address - Fax:
Practice Address - Street 1:4950 S LE JEUNE RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2231
Practice Address - Country:US
Practice Address - Phone:305-239-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019562363LF0000X
CO15-132246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant