Individual
TINA MICHELE TILLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
5224 E I 240 SERVICE RD STE 201, OKLAHOMA CITY, OK 73135-2607
(405) 608-3800
Mailing address
7800 NW 85TH TER, OKLAHOMA CITY, OK 73132-3385
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
89076
OK
363LF0000X
Family Nurse Practitioner
Primary
89076
OK
Other
Enumeration date
06/10/2020
Last updated
09/11/2023
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