Provider Demographics
NPI:1912530809
Name:RIVERA, VICTORIA LYNN (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:LYNN
Last Name:RIVERA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:LYNN
Other - Last Name:FRAGOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:636 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2668
Mailing Address - Country:US
Mailing Address - Phone:239-424-3513
Mailing Address - Fax:239-424-4039
Practice Address - Street 1:636 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2668
Practice Address - Country:US
Practice Address - Phone:239-424-3513
Practice Address - Fax:239-424-4039
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty