Provider Demographics
NPI:1023743929
Name:RILEY, TAMIKA ALENA (FNP-C)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:ALENA
Last Name:RILEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TAMIKA
Other - Middle Name:ALENA
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:860 HARING LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-8700
Mailing Address - Country:US
Mailing Address - Phone:646-836-2141
Mailing Address - Fax:
Practice Address - Street 1:7780 LAKE UNDERHILL RD STE 111
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8218
Practice Address - Country:US
Practice Address - Phone:407-704-8005
Practice Address - Fax:407-704-2888
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily