Provider Demographics
NPI:1982355178
Name:TILUS, ERICA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:TILUS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HIDDEN SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-6124
Mailing Address - Country:US
Mailing Address - Phone:407-844-9440
Mailing Address - Fax:
Practice Address - Street 1:200 E ROBINSON ST STE 425
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-4347
Practice Address - Country:US
Practice Address - Phone:407-787-9777
Practice Address - Fax:407-583-4988
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017523363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health