| Doctor Name: | MS. STEPHANIE IWALANI RIVERA |
| NPI Number: | 1114361110 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | 0024169839 |
| Business Practice Address: | 120 Heartland Way Wauchula, FL - 338735000 |
| Business Phone Number: | 8637671414 |
| Business Fax Number: | 8637671763 |
| Mailing Address: | 120 Heartland Way, WAUCHULA |
| State: | FL |
| Postal Code: | 338735000 |
| Phone Number: | 8637671414 |
| Fax Number: | 8637671763 |
| NPI Enumeration Date: | 04/20/2013 |
| NPI Last Update Date: | 08/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 0024169839 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |