Healthcare Provider Details

I. General information

NPI: 1902164445
Provider Name (Legal Business Name): RIANA COLVIN SKORUPA ARNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIANA COLVIN BRONSON-CHEATHAM ARNP-BC

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27849 LAKE JEM RD
MOUNT DORA FL
32757-9304
US

IV. Provider business mailing address

27849 LAKE JEM RD
MOUNT DORA FL
32757-9304
US

V. Phone/Fax

Practice location:
  • Phone: 352-735-2975
  • Fax: 352-735-2975
Mailing address:
  • Phone: 352-735-2975
  • Fax: 352-735-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP1839152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: