Individual
TYWAUN KRETRICA TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4210 W LINEBAUGH AVE, TAMPA, FL 33624-5241
(813) 884-0923
(813) 377-1006
Mailing address
38135 MARKET SQUARE DR, ZEPHYRHILLS, FL 33542-7505
(352) 567-0188
(813) 355-5101
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
M8387
TX
207RC0000X
Cardiovascular Disease Physician
M8387
TX
207RC0000X
Cardiovascular Disease Physician
ME169173
FL
207RI0011X
Interventional Cardiology Physician
Primary
ME169173
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
BLUE CROSS BLUE SHIELD
TX
05
—
PENDING
—
TX
Enumeration date
06/28/2006
Last updated
02/07/2025
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