Healthcare Provider Details

I. General information

NPI: 1164069019
Provider Name (Legal Business Name): TILLEN JOSEPH PERRY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 ALBERT SABIN WAY
CINCINNATI OH
45267-2827
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-4831
  • Fax: 513-558-4858
Mailing address:
  • Phone: 513-585-5505
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRNCNP026025
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: