Individual
DR. SUWARNA M TILAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10175 FORTUNE PKWY, SUITE 401, JACKSONVILLE, FL 32256-6746
(904) 519-0008
(904) 519-0007
Mailing address
430 COLLEGE DR, SUITE 100-102, MIDDLEBURG, FL 32068-8530
(904) 298-1994
(904) 298-1973
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME71441
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05527
HUMANA
FL
01
—
211581
AVMED
FL
05
—
250510000
—
FL
01
—
2941247
AETNA
FL
01
—
32326
BCBS
FL
Enumeration date
07/26/2006
Last updated
11/18/2009
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