Provider Demographics
NPI:1760145924
Name:NILES, AMBER NICHOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:NICHOLE
Last Name:NILES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 NW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5109
Mailing Address - Country:US
Mailing Address - Phone:954-629-5234
Mailing Address - Fax:
Practice Address - Street 1:7229 W OAKLAND PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-1004
Practice Address - Country:US
Practice Address - Phone:954-824-2616
Practice Address - Fax:954-667-4007
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily