MEDICARE: EMILY TILLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN.CNP.0035333	OH

General Provider Information

NPI Number	:	1487423539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY TILLEY

Provider Business Mailing Address
First Line	:	15900 SNOW RD
Second Line	:	SUITE 200
City	:	BROOK PARK
State	:	OH
Zip	:	44142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15900 SNOW RD STE 200
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-2860
Country	:	US
Telephone Number	:	216-265-0772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2023
Last Update Date	:	12/29/2023

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Directions to “ EMILY TILLEY ” Practice Location

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