Provider Demographics
NPI:1437727930
Name:TILTON, MARIA ADRIANNA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ADRIANNA
Last Name:TILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-4307
Mailing Address - Country:US
Mailing Address - Phone:631-617-7449
Mailing Address - Fax:
Practice Address - Street 1:784 FULTON AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-4307
Practice Address - Country:US
Practice Address - Phone:631-617-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341470164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse