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General NPI Number Information
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NPI Number | 1154872539
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Entity Type | Individual
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Provider Name | TILLIE BORRELLI DNP
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Gender | Female
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 12921 S VISTA STATION BLVD
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City | DRAPER
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State | UT
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Zip | 84020-2376
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Country | US
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Telephone | 801-823-5811
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Fax |
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Provider Business Mailing Address
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Address Line | 5184 RODEO CIR
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City | OAKLEY
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State | UT
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Zip | 84055-2101
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Country | US
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Telephone | 307-690-5397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 907230
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6637908-4405
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License Number State | UT
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