Provider Demographics
NPI:1194573089
Name:RIVERA, EILEEN CORBIN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:CORBIN
Last Name:RIVERA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1947 PILLARD SMT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1992
Mailing Address - Country:US
Mailing Address - Phone:210-712-5191
Mailing Address - Fax:
Practice Address - Street 1:BEXAR COUNTY SHERRIFF OFFICE
Practice Address - Street 2:200 NORTH COMAL ST
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3505
Practice Address - Country:US
Practice Address - Phone:210-712-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily