Provider Demographics
NPI:1366826976
Name:TITTLE, AMY ELIZABETH (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:TITTLE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:30775 STEPHENSON HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1618
Mailing Address - Country:US
Mailing Address - Phone:248-733-9904
Mailing Address - Fax:248-733-9906
Practice Address - Street 1:30775 STEPHENSON HWY
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1618
Practice Address - Country:US
Practice Address - Phone:248-733-9904
Practice Address - Fax:248-733-9906
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704233391363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health