Provider Demographics
NPI:1679210678
Name:RIVERO GORT, PEDRO MARCEL (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:MARCEL
Last Name:RIVERO GORT
Suffix:
Gender:M
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21660 SW 131ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-2667
Mailing Address - Country:US
Mailing Address - Phone:786-444-4976
Mailing Address - Fax:
Practice Address - Street 1:21660 SW 131ST CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-2667
Practice Address - Country:US
Practice Address - Phone:786-444-4976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-352829106S00000X
FL2022009455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily