Provider Demographics
NPI:1982235800
Name:RIVIERA, JESSICA KATE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:KATE
Last Name:RIVIERA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:KATE
Other - Last Name:SHOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:777 N ASHLEY DR UNIT 1714
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 N ASHLEY DR UNIT 1714
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4372
Practice Address - Country:US
Practice Address - Phone:727-744-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9304030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily