Provider Demographics
NPI:1487339917
Name:WILEY, CHRISTOPHER AMBLER (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:AMBLER
Last Name:WILEY
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MIRROR LAKE DR N APT 402
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3256
Mailing Address - Country:US
Mailing Address - Phone:727-871-5524
Mailing Address - Fax:
Practice Address - Street 1:2837 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8603
Practice Address - Country:US
Practice Address - Phone:727-334-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018962363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health