Provider Demographics
NPI:1114642840
Name:TILONG, PATRICIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:TILONG
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:TILONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:12508 E 13TH PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6353
Mailing Address - Country:US
Mailing Address - Phone:303-618-9143
Mailing Address - Fax:
Practice Address - Street 1:46TH MDG BUCKLEY SPACE FORCE BASE, CO
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011
Practice Address - Country:US
Practice Address - Phone:303-618-9143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0193177163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse