Provider Demographics
NPI:1487043899
Name:TILLER, COURTNEY (ARNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:TILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W GORE ST STE 405
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1049
Mailing Address - Country:US
Mailing Address - Phone:321-841-9340
Mailing Address - Fax:321-841-9344
Practice Address - Street 1:100 W GORE ST STE 405
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1049
Practice Address - Country:US
Practice Address - Phone:321-841-9340
Practice Address - Fax:321-841-9344
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9325843363LF0000X
FLAPRN9325843363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily