Provider Demographics
NPI:1063862837
Name:NOLES, AMIRA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIRA
Middle Name:ANN
Last Name:NOLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SUNNINGDALE CV
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4301
Mailing Address - Country:US
Mailing Address - Phone:313-600-5589
Mailing Address - Fax:
Practice Address - Street 1:996 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2824
Practice Address - Country:US
Practice Address - Phone:313-600-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301110429208100000X
FLME142763208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation