Provider Demographics
NPI:1306236435
Name:RIVERA, AMY R (APRN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:RIVERA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 MALLORY CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1822
Mailing Address - Country:US
Mailing Address - Phone:689-207-0654
Mailing Address - Fax:407-396-1028
Practice Address - Street 1:2954 MALLORY CIR STE 200
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-1822
Practice Address - Country:US
Practice Address - Phone:689-207-0654
Practice Address - Fax:407-396-1028
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3073412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily