Provider Demographics
NPI:1447478326
Name:RIVERA, GRISELLE ESTHER (APNC)
Entity type:Individual
Prefix:MS
First Name:GRISELLE
Middle Name:ESTHER
Last Name:RIVERA
Suffix:
Gender:F
Credentials:APNC
Other - Prefix:MS
Other - First Name:GRISELLE
Other - Middle Name:ESTHER
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:410 CELEBRATION PLACE: CELEBRATION OB/GYN ASSOCIATES
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747
Mailing Address - Country:US
Mailing Address - Phone:407-566-2229
Mailing Address - Fax:407-566-2499
Practice Address - Street 1:410 CELEBRATION PL
Practice Address - Street 2:SUITE 208
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5433
Practice Address - Country:US
Practice Address - Phone:407-566-2229
Practice Address - Fax:407-566-2499
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN11466100363LX0001X
FLARNP9291443363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0244791Medicaid
NJ195588C04OtherMEDICARE