Healthcare Provider Details

I. General information

NPI: 1679144877
Provider Name (Legal Business Name): AMANDA LILES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 11TH AVE STE C1
SHALIMAR FL
32579-1300
US

IV. Provider business mailing address

1221 W LAKEVIEW AVE
PENSACOLA FL
32501-1857
US

V. Phone/Fax

Practice location:
  • Phone: 850-332-5840
  • Fax: 850-595-1400
Mailing address:
  • Phone: 850-469-3500
  • Fax: 850-595-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11017500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: