Healthcare Provider Details

I. General information

NPI: 1972408052
Provider Name (Legal Business Name): RILEY MADISON MINNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-4802
US

IV. Provider business mailing address

3871 GRANDPINE WAY # 5-115
CASSELBERRY FL
32707-4358
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2200
  • Fax:
Mailing address:
  • Phone: 916-218-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11051457
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: