Provider Demographics
NPI:1407811920
Name:TILTON, TAMMY ANNE (RN CS FNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANNE
Last Name:TILTON
Suffix:
Gender:F
Credentials:RN CS FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:600 OLD SOMERSET AVE
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764-0586
Mailing Address - Country:US
Mailing Address - Phone:508-824-7557
Mailing Address - Fax:508-824-8296
Practice Address - Street 1:600 OLD SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:NORTH DIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02764-0586
Practice Address - Country:US
Practice Address - Phone:508-824-7557
Practice Address - Fax:508-824-8296
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP2242OtherBCBS
M15639OtherBCBS
NP2242OtherBCBS
MANP2242Medicare PIN
MAM15639Medicare PIN