Healthcare Provider Details

I. General information

NPI: 1518434158
Provider Name (Legal Business Name): DEBORAH CHRISTINE TILLMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 SOMMERVILLE RD.
CHIMACUM WA
98325
US

IV. Provider business mailing address

PO BOX 251
PORT HADLOCK WA
98339-0251
US

V. Phone/Fax

Practice location:
  • Phone: 360-301-1857
  • Fax:
Mailing address:
  • Phone: 360-301-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60879556
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: