Healthcare Provider Details

I. General information

NPI: 1780474205
Provider Name (Legal Business Name): ALICIA LYNN RILEY RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA LYNN DAVIS

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 LAGO VISTA DR
GREEN COVE SPRINGS FL
32043-8793
US

IV. Provider business mailing address

3203 LAGO VISTA DR
GREEN COVE SPRINGS FL
32043-8793
US

V. Phone/Fax

Practice location:
  • Phone: 253-441-1071
  • Fax:
Mailing address:
  • Phone: 253-441-1071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278G1100X
TaxonomyGeneral Care Certified Respiratory Therapist
License NumberRT14836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: