Provider Demographics
NPI:1871389791
Name:RIVERA-RODRIGUEZ, NICOLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RIVERA-RODRIGUEZ
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 PACIFIC AVE # B01
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-0046
Mailing Address - Country:US
Mailing Address - Phone:203-500-0274
Mailing Address - Fax:
Practice Address - Street 1:275 HOBART ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3396
Practice Address - Country:US
Practice Address - Phone:732-376-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15318200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily