Individual
KATHLEEN S TILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1846 HIGHWAY 1 STE B, ROCKLEDGE, FL 32955-2822
(321) 434-9564
(321) 434-7078
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-9564
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11028260
FL
363LF0000X
Family Nurse Practitioner
11028260
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119862500
—
FL
01
—
RZ885
MEDICARE HF
FL
Enumeration date
08/24/2023
Last updated
12/05/2024
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