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General NPI Number Information
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NPI Number | 1639728777
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Entity Type | Individual
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Provider Name | SUZANNE M TILLMAN DNP, APRN, NNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 1800 E FLORENCE BLVD
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City | CASA GRANDE
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State | AZ
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Zip | 85122-5303
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Country | US
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Telephone | 678-296-9105
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 MULBERRY LAKE DR
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City | DACULA
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State | GA
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Zip | 30019-4638
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Country | US
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Telephone | 678-296-9105
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | RN102011
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 291116
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 11027042
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License Number State | FL
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