Provider Demographics
NPI:1952156309
Name:TILGHMAN, DAISY ANNE
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:ANNE
Last Name:TILGHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 CANALSIDE ST UNIT 2019
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-6033
Mailing Address - Country:US
Mailing Address - Phone:443-975-0625
Mailing Address - Fax:
Practice Address - Street 1:630 CANALSIDE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-6029
Practice Address - Country:US
Practice Address - Phone:443-975-0625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant