Healthcare Provider Details

I. General information

NPI: 1730778481
Provider Name (Legal Business Name): DEANNA SUZANNE RILEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 STATE ROAD 559 # 118
AUBURNDALE FL
33823-9338
US

IV. Provider business mailing address

423 QUAIL HOLLOW RD
AUBURNDALE FL
33823-9313
US

V. Phone/Fax

Practice location:
  • Phone: 863-371-7020
  • Fax:
Mailing address:
  • Phone: 863-258-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: