Provider Demographics
NPI:1356513378
Name:TITTLER, MARA HILL (FNP)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:HILL
Last Name:TITTLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10805 HINMAN RD
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-1814
Mailing Address - Country:US
Mailing Address - Phone:267-408-9219
Mailing Address - Fax:
Practice Address - Street 1:5015 CAMPUSWOOD DR
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-4232
Practice Address - Country:US
Practice Address - Phone:833-442-1509
Practice Address - Fax:855-418-2317
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX825430363LF0000X, 363LF0000X
NYF335428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily