Tillquist, Jackson E.

Tillquist, Jackson E. is an individual health care provider with primary practice located at 1840 Mease Dr Suite 200, Safety Harbor FL 34695-6602. He recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Critical Care Medicine, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Tillquist, Jackson E. can be contacted via phone (727) 724-8611.

Contact Information

Primary practice address
1840 Mease Dr Suite 200 Safety Harbor FL 34695-6602
Phone: (727) 724-8611
Fax: (727) 724-0425
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Critical Care Medicine 163WC0200X 9258226 Florida
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X ARNP9258226 Florida

Profile Details

NPI number 1720442940
LBN Legal business name Tillquist, Jackson E.
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2016
Last updated Oct 14th, 2016 - about 9 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 1720442940 NPPES
Florida MEDICAID 018482900

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