Provider Demographics
NPI:1669899019
Name:RIVERA, JACQUELINE FRANCIS (HHA)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:FRANCIS
Last Name:RIVERA
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HICKORY PL
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2404
Mailing Address - Country:US
Mailing Address - Phone:631-647-3231
Mailing Address - Fax:
Practice Address - Street 1:4 HICKORY PL
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2404
Practice Address - Country:US
Practice Address - Phone:631-647-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00298059374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide