Provider Demographics
NPI:1912418377
Name:RIVERA, REBEKA ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:REBEKA
Middle Name:ANN
Last Name:RIVERA
Suffix:
Gender:F
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:PO BOX 3130
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3130
Mailing Address - Country:US
Mailing Address - Phone:352-369-0286
Mailing Address - Fax:352-867-5076
Practice Address - Street 1:524 SE OSCEOLA ST STE 100
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2322
Practice Address - Country:US
Practice Address - Phone:772-419-2379
Practice Address - Fax:772-419-2377
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9234118163W00000X
FLARNP9234118363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9234118OtherSTATE MEDICAL LICENSE