Provider Demographics
NPI:1053681114
Name:TANG TILT, ANNA VICTORIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:VICTORIA
Last Name:TANG TILT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ANNA VICTORIA
Other - Middle Name:TANG
Other - Last Name:TILT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27484 KOBUK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-8131
Mailing Address - Country:US
Mailing Address - Phone:760-803-5548
Mailing Address - Fax:
Practice Address - Street 1:1850 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-3718
Practice Address - Country:US
Practice Address - Phone:951-438-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22040363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant