Provider Demographics
NPI:1467692889
Name:TILLMAN, JANET D (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:D
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 HWY 58 N UNIT C
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:28585
Mailing Address - Country:US
Mailing Address - Phone:252-649-2770
Mailing Address - Fax:252-448-1670
Practice Address - Street 1:418 HIGHWAY 58 NORTH UNIT C
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NC
Practice Address - Zip Code:28585-9619
Practice Address - Country:US
Practice Address - Phone:252-649-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8973980Medicaid