Provider Demographics
NPI:1871162917
Name:RIVERA, ELIZABETH DENISE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DENISE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2 TAMPA GENERAL CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3571
Mailing Address - Country:US
Mailing Address - Phone:813-844-7233
Mailing Address - Fax:
Practice Address - Street 1:2 TAMPA GENERAL CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-821-8038
Practice Address - Fax:813-974-4325
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11013773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116536000Medicaid
FLHXE4UOtherBLUE CROSS BLUE SHIELD