Provider Demographics
NPI:1780713180
Name:TILTON, BRENDA D (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:D
Last Name:TILTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 RALEIGH PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2615
Mailing Address - Country:US
Mailing Address - Phone:937-283-9289
Mailing Address - Fax:937-283-9343
Practice Address - Street 1:1261 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-9389
Practice Address - Country:US
Practice Address - Phone:937-283-9289
Practice Address - Fax:937-283-9343
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily