Provider Demographics
NPI:1194574582
Name:RIVERA SERRANO, FRANGELY ANTIOSKY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:FRANGELY
Middle Name:ANTIOSKY
Last Name:RIVERA SERRANO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 SEA MOUNTAIN HWY STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-2496
Mailing Address - Country:US
Mailing Address - Phone:843-290-8097
Mailing Address - Fax:
Practice Address - Street 1:802 SEA MOUNTAIN HWY STE A
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-2496
Practice Address - Country:US
Practice Address - Phone:843-290-8097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily