Most Relevant Information
Provider Data
| NPI Number: | 1003298969 |
| Provider Name: | AMANDA MICHELLE OUTLY PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | PA9110768 |
Most Important Dates
| Enumeration Date: | 06/26/2015 |
| Last Updated: | 01/17/2019 |
Provider Practice Location
2001 E. HIGHWAY 20
FAMILY MEDICINE DEPARTMENT
NICEVILLE
FL
325788826
Practice Location Phone/Fax
| Phone: | 8508976600 |
| Fax: | 8508970623 |
Provider Mailing Location
1005 MAR WALT DRIVE
FAMILY MEDICINE DEPARTMENT
FORT WALTON BEACH
FL
325476796
Provider Mailing Phone/Fax
| Phone: | 8508636600 |
| Fax: | 8508620977 |