Provider Demographics
NPI:1770533853
Name:RIVERA, JOSE R (CRNA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:RIVERA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 BEE RIDGE RD
Mailing Address - Street 2:SUITE D3
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1508
Mailing Address - Country:US
Mailing Address - Phone:941-342-8200
Mailing Address - Fax:941-342-8201
Practice Address - Street 1:5560 BEE RIDGE RD
Practice Address - Street 2:SUITE D3
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1508
Practice Address - Country:US
Practice Address - Phone:941-342-8200
Practice Address - Fax:941-342-8201
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9162399367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2565XOtherBLUE CROSS BLUE SHIELD
FLP00276170OtherMEDICARE RAIL ROAD
FLG2565XMedicare ID - Type Unspecified