Provider Demographics
NPI:1982110276
Name:ROMAN RIVERA, ANGELICA SHARYS (MD)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:SHARYS
Last Name:ROMAN RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:1111 NE 25TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5667
Practice Address - Country:US
Practice Address - Phone:352-351-7000
Practice Address - Fax:352-236-8610
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19822208D00000X
FLACN1437208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice