Provider Demographics
NPI:1780046821
Name:BRILES, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BRILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 MANATEE AVE W
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-2378
Mailing Address - Country:US
Mailing Address - Phone:941-761-8505
Mailing Address - Fax:
Practice Address - Street 1:6400 MANATEE AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-2378
Practice Address - Country:US
Practice Address - Phone:941-761-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9323621363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care