Provider Demographics
NPI:1063706356
Name:BIVONA, ANN E (RN)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:BIVONA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 SOUTH OCEAN DRIVE #1612
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019
Mailing Address - Country:US
Mailing Address - Phone:516-456-2119
Mailing Address - Fax:631-231-3057
Practice Address - Street 1:3725 SOUTH OCEAN DRIVE #1612
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019
Practice Address - Country:US
Practice Address - Phone:516-456-2119
Practice Address - Fax:631-231-3057
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2019-04-12
Deactivation Date:2014-11-25
Deactivation Code:
Reactivation Date:2019-04-12
Provider Licenses
StateLicense IDTaxonomies
NY459516163WA2000X, 163WC0200X, 163WE0003X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02146270Medicaid