# TNTMD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467867168
- **Authorized official:** TINA N TILLIS MD (OWNER/ PROVIDER)
- **Authorized official phone:** (904) 345-3473

## Contact information

- **Practice address:** 3890 DUNN AVE, SUITE 902, JACKSONVILLE, FL 32218-6428
- **Practice address phone:** (904) 345-3473
- **Practice address fax:** (904) 208-5892
- **Mailing address:** 3890 DUNN AVE, SUITE 902, JACKSONVILLE, FL 32218-6428
- **Mailing address phone:** (904) 345-3473
- **Mailing address fax:** (904) 208-5892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME64518 | FL | Yes |

## Other

- **Enumeration date:** 06/23/2014
- **Last updated:** 06/23/2014