Tillis, Tina Nannette

Tillis, Tina Nannette is an individual health care provider with primary practice located at 3890 Dunn Ave #902, Jacksonville FL 32218-6428. She recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as her primary health care specialty. Tillis, Tina Nannette can be contacted via phone (904) 345-3473.

Contact Information

Primary practice address
3890 Dunn Ave #902 Jacksonville FL 32218-6428
Phone: (904) 345-3473
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X ME64518 Florida

Profile Details

NPI number 1174595318
LBN Legal business name Tillis, Tina Nannette
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 2nd, 2006
Last updated Feb 12th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174595318 NPPES
Florida MEDICAID 3732029-00
Florida Other P00061611
Florida MEDICAID 000581941F

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