Provider Demographics
NPI:1669763470
Name:RIVERA, ROSELYN A (CNA)
Entity type:Individual
Prefix:MRS
First Name:ROSELYN
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 HOBSON ST
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-7516
Mailing Address - Country:US
Mailing Address - Phone:386-479-3752
Mailing Address - Fax:
Practice Address - Street 1:921 HOBSON ST
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-7516
Practice Address - Country:US
Practice Address - Phone:386-479-3752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL199937374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide