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General NPI Number Information
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NPI Number | 1356343149
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Entity Type | Individual
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Provider Name | FELICIA MAE TILLMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 4200 BECKNER RD
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City | SANTA FE
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State | NM
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Zip | 87507-3774
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Country | US
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Telephone | 505-477-2200
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Fax | 505-782-1902
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Provider Business Mailing Address
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Address Line | 555 REPUBLIC DR SUITE # 460
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City | PLANO
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State | TX
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Zip | 75074-5481
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Country | US
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Telephone | 972-644-2819
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Fax | 972-680-2949
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G79172
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | K1100
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License Number State | TX
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