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NPI Code Detail

MEDICARE: ELLEN TILLETT

MEDICARE: ELLEN TILLETT
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
1363LF0000XFamily Nurse PractitionerARNP 3176512FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326236621
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN TILLETT
Provider Business Mailing Address
First Line : 11000 N MILITARY TRL
Second Line :
City : PALM BEACH GARDENS
State : FL
Zip : 33410-6504
Country : US
Telephone Number : 561-626-7542
Fax Number :
Provider Business Practice Location Address
First Line : 11000 N MILITARY TRL
Second Line :
City : PALM BEACH GARDENS
State : FL
Zip : 33410-6504
Country : US
Telephone Number : 561-626-7542
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2007
Last Update Date : 04/30/2014

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