Provider Demographics
NPI:1013473180
Name:LILES, SARA BETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:LILES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CEDAR HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7595
Mailing Address - Country:US
Mailing Address - Phone:919-414-9211
Mailing Address - Fax:
Practice Address - Street 1:4414 LAKE BOONE TRL STE 108
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7522
Practice Address - Country:US
Practice Address - Phone:919-784-2300
Practice Address - Fax:919-784-2301
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLILE-0PUM9U363LF0000X
NC5011481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily