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General NPI Number Information
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NPI Number | 1679144877
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Entity Type | Individual
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Provider Name | AMANDA LILES APRN
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 1 11TH AVE STE C1
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City | SHALIMAR
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State | FL
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Zip | 32579-1300
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Country | US
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Telephone | 850-332-5840
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Fax | 850-595-1400
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Provider Business Mailing Address
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Address Line | 1221 W LAKEVIEW AVE
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City | PENSACOLA
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State | FL
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Zip | 32501-1857
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Country | US
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Telephone | 850-469-3500
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Fax | 850-595-1400
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11017500
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License Number State | FL
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