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NPI Code Detail

MEDICARE: REILLY ROBERTS FNP

MEDICARE: REILLY ROBERTS FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner236216AR

General Provider Information

NPI Number : 1194684720
Entity Type Code : Individual
Provider Name (Legal Business Name) : REILLY ROBERTS FNP
Provider Business Mailing Address
First Line : 3607 SW 106TH ST
Second Line :
City : GAINESVILLE
State : FL
Zip : 32608-9177
Country : US
Telephone Number : 662-588-9889
Fax Number :
Provider Business Practice Location Address
First Line : 1720 S WALTON BLVD STE 6
Second Line :
City : BENTONVILLE
State : AR
Zip : 72712-7533
Country : US
Telephone Number : 479-464-0834
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2026
Last Update Date : 01/20/2026

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