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General NPI Number Information
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NPI Number | 1578193520
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Entity Type | Individual
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Provider Name | QUANKELA TILLMAN
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Gender | Female
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 10005 N DALE MABRY HWY STE 115
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City | TAMPA
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State | FL
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Zip | 33618-4409
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Country | US
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Telephone | 813-284-8900
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Fax | 813-867-4600
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Provider Business Mailing Address
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Address Line | 2604 LINDELL AVE
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City | TAMPA
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State | FL
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Zip | 33610-7757
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Country | US
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Telephone |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 11003758
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License Number State | FL
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