Provider Demographics
NPI:1205881380
Name:RILEY, DENISE YVETTE (ANP-BC, CNRN)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:YVETTE
Last Name:RILEY
Suffix:
Gender:F
Credentials:ANP-BC, CNRN
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1601 SW ARCHER RD
Mailing Address - Street 2:MALCOM RANDALL VAMC MS-127
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610
Mailing Address - Country:US
Mailing Address - Phone:352-376-1611
Mailing Address - Fax:352-374-6153
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-374-6153
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2955092363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305800000Medicaid
Q12933Medicare UPIN
FLY037VZMedicare PIN
FL305800000Medicaid