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General NPI Number Information
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NPI Number | 1265139976
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Entity Type | Individual
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Provider Name | RILEY RANDOL LEE JR APRN
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Gender | Male
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 1038 W. NORTH BLVD SUITE 102
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City | LEESBURG
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State | FL
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Zip | 34748-5077
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Country | US
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Telephone | 352-315-1627
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Fax | 352-326-8744
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Provider Business Mailing Address
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Address Line | 1038 W. NORTH BLVD SUITE 102
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City | LEESBURG
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State | FL
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Zip | 34748-5077
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Country | US
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Telephone | 352-315-1627
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Fax | 352-326-8744
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11024113
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License Number State | FL
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