Provider Demographics
NPI:1518416510
Name:RILES, ROXENE SUSAN (PHD, FNP-C, RN)
Entity Type:Individual
Prefix:DR
First Name:ROXENE
Middle Name:SUSAN
Last Name:RILES
Suffix:
Gender:F
Credentials:PHD, FNP-C, RN
Other - Prefix:
Other - First Name:ROXENE
Other - Middle Name:SUSAN
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3955 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-6003
Mailing Address - Country:US
Mailing Address - Phone:727-347-2557
Mailing Address - Fax:727-345-8972
Practice Address - Street 1:3955 58TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709
Practice Address - Country:US
Practice Address - Phone:727-347-2557
Practice Address - Fax:727-345-8972
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-02
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3299832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily