MEDICARE: TAMMY ANNE TILTON RN CS FNP

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	232498	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP2242	OTHER		BCBS
2	M15639	OTHER		BCBS

General Provider Information

NPI Number	:	1407811920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY ANNE TILTON RN CS FNP

Provider Business Mailing Address
First Line	:	PO BOX 586
Second Line	:	600 OLD SOMERSET AVE
City	:	NORTH DIGHTON
State	:	MA
Zip	:	02764-0586
Country	:	US
Telephone Number	:	508-824-7557
Fax Number	:	508-824-8296

Provider Business Practice Location Address
First Line	:	600 OLD SOMERSET AVE
Second Line	:
City	:	NORTH DIGHTON
State	:	MA
Zip	:	02764-0586
Country	:	US
Telephone Number	:	508-824-7557
Fax Number	:	508-824-8296

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	01/08/2010

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