Individual
DR. TINA NANNETTE TILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3890 DUNN AVE, #902, JACKSONVILLE, FL 32218-6428
(904) 345-3473
Mailing address
P O BOX 10525, JACKSONVILLE, FL 32247-0525
(904) 345-3473
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME64518
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000581941F
—
GA
05
—
3732029-00
—
FL
01
—
P00061611
RAILROAD MEDICARE
FL
Enumeration date
02/02/2006
Last updated
02/12/2014
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