Individual
TILA BROADWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP-BC
Contact information
Practice address
23802 HIGHWAY 59 N, KINGWOOD, TX 77339-1510
(281) 312-5400
(281) 312-5400
Mailing address
23802 HIGHWAY 59 N, KINGWOOD, TX 77339-1510
(281) 312-5400
(281) 312-5440
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
AP125930
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8104NK
BCBS
TX
Enumeration date
07/30/2014
Last updated
03/26/2015
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