Provider Demographics
NPI:1902164445
Name:SKORUPA, RIANA COLVIN (ARNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:RIANA
Middle Name:COLVIN
Last Name:SKORUPA
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:MRS
Other - First Name:RIANA
Other - Middle Name:COLVIN
Other - Last Name:BRONSON-CHEATHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-BC
Mailing Address - Street 1:27849 LAKE JEM RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-9304
Mailing Address - Country:US
Mailing Address - Phone:352-735-2975
Mailing Address - Fax:352-735-2975
Practice Address - Street 1:27849 LAKE JEM RD
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-9304
Practice Address - Country:US
Practice Address - Phone:352-735-2975
Practice Address - Fax:352-735-2975
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1839152363LF0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP1839152OtherSTATE LICENSE NUMBER