Provider Demographics
NPI:1518434158
Name:TILLMAN, DEBORAH CHRISTINE (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CHRISTINE
Last Name:TILLMAN
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:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-0251
Mailing Address - Country:US
Mailing Address - Phone:360-301-1857
Mailing Address - Fax:
Practice Address - Street 1:1064 SOMMERVILLE RD.
Practice Address - Street 2:
Practice Address - City:CHIMACUM
Practice Address - State:WA
Practice Address - Zip Code:98325
Practice Address - Country:US
Practice Address - Phone:360-301-1857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60879556363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60879556OtherSTATE OF WASHINGTON NURSING COMMISSION