Provider Demographics
NPI:1962122598
Name:RILEY, ROSALYN A
Entity type:Individual
Prefix:MRS
First Name:ROSALYN
Middle Name:A
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9273 CANARY IVY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-6001
Mailing Address - Country:US
Mailing Address - Phone:904-559-6959
Mailing Address - Fax:904-467-3848
Practice Address - Street 1:9273 CANARY IVY LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-6001
Practice Address - Country:US
Practice Address - Phone:904-559-6959
Practice Address - Fax:904-467-3848
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL404256253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care