Healthcare Provider Details

I. General information

NPI: 1285506816
Provider Name (Legal Business Name): EMMA FAITH TILLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMMA FAITH KURZAWA

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4195 MARINER BLVD
SPRING HILL FL
34609-2470
US

IV. Provider business mailing address

4580 DELTONA BLVD
SPRING HILL FL
34606-1644
US

V. Phone/Fax

Practice location:
  • Phone: 352-340-0530
  • Fax:
Mailing address:
  • Phone: 352-515-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: