Healthcare Provider Details

I. General information

NPI: 1356343149
Provider Name (Legal Business Name): FELICIA MAE TILLMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELICIA TILLMAN TOE MD

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BECKNER RD
SANTA FE NM
87507-3774
US

IV. Provider business mailing address

555 REPUBLIC DR SUITE # 460
PLANO TX
75074-5481
US

V. Phone/Fax

Practice location:
  • Phone: 505-477-2200
  • Fax: 505-782-1902
Mailing address:
  • Phone: 972-644-2819
  • Fax: 972-680-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG79172
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberK1100
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: