Basic Information
| Provider Information | |||||||||
| NPI: | 1659995702 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILES | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12850 TIMBER RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339138616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144433046 | ||||||||
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| Practice Location | |||||||||
| Address1: | NAVAL HEALTH CLINIC HAWAII | ||||||||
| Address2: | 480 CENTRAL AVENUE-JOINT BASE PEARL HARBOR | ||||||||
| City: | HICKAM | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968604908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084731880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2020 | ||||||||
| LastUpdateDate: | 06/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 9407064 | FL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.