Healthcare Provider Details

I. General information

NPI: 1558286096
Provider Name (Legal Business Name): RILEY HUMBERSTONE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 DREW ST STE 200
CLEARWATER FL
33765-3215
US

IV. Provider business mailing address

11201 122ND AVE APT 225
LARGO FL
33778-2631
US

V. Phone/Fax

Practice location:
  • Phone: 727-447-4536
  • Fax:
Mailing address:
  • Phone: 585-698-5409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9122066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: