Healthcare Provider Details

I. General information

NPI: 1699462259
Provider Name (Legal Business Name): HEGE RIISE PH.D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20747 STERLINGTON DR
LAND O LAKES FL
34638-4317
US

IV. Provider business mailing address

20747 STERLINGTON DR
LAND O LAKES FL
34638-4317
US

V. Phone/Fax

Practice location:
  • Phone: 813-625-8853
  • Fax:
Mailing address:
  • Phone: 813-625-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY9669
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: