Provider Demographics
NPI:1013430552
Name:TILTON, LAYLA ZOE (NP-C)
Entity Type:Individual
Prefix:
First Name:LAYLA
Middle Name:ZOE
Last Name:TILTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 SE LEITHGOW ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7427
Mailing Address - Country:US
Mailing Address - Phone:636-493-0322
Mailing Address - Fax:
Practice Address - Street 1:501 SE OSCEOLA ST STE 301
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2347
Practice Address - Country:US
Practice Address - Phone:772-223-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9457652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner