Healthcare Provider Details

I. General information

NPI: 1881909752
Provider Name (Legal Business Name): LIANNE RILEY MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIANNE MARIE RILEY PA-C

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 VENETIAN COURT SUITE 1
NAPLES FL
34109
US

IV. Provider business mailing address

173 WEST MAIN ST
BREVARD NC
28712
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-9337
  • Fax: 239-596-9466
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: