MEDICARE: CELYA N TILLEY FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	704818	TX
2	363L00000X	Nurse Practitioner	AP124789	TX

General Provider Information

NPI Number	:	1144650805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELYA N TILLEY FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 183432
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76096-3432
Country	:	US
Telephone Number	:	817-907-5843
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 YUCCA AVE
Second Line	:	SUITE NUMBER #129
City	:	FORT WORTH
State	:	TX
Zip	:	76111-6067
Country	:	US
Telephone Number	:	817-759-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2013
Last Update Date	:	06/26/2023

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