Provider Demographics
NPI:1780474205
Name:RILEY, ALICIA LYNN (RRT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYNN
Last Name:RILEY
Suffix:
Gender:
Credentials:RRT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:LYNN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3203 LAGO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-8793
Mailing Address - Country:US
Mailing Address - Phone:253-441-1071
Mailing Address - Fax:
Practice Address - Street 1:3203 LAGO VISTA DR
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-8793
Practice Address - Country:US
Practice Address - Phone:253-441-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT148362278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care