Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO4220 | FL |
Y | 222Z00000X | Podiatrist | PO4220 | FL |
N | 213E00000X | Podiatrist | PR552 | FL |
N | 222Z00000X | Podiatrist | PR552 | FL |
NPI | 1023502234 |
---|---|
Provider Name | Dr. Emily Niles |
First Address | Jacksonville Beach, FL 32250-3626 |
Second Address | Jacksonville Beach, FL 32250-3626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2018 |
Last Update Date | 29/11/2021 |