Individual
SHAUNDRIA TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5749 TAMPICO RD, JACKSONVILLE, FL 32244-1736
(904) 537-9701
Mailing address
5749 TAMPICO RD, JACKSONVILLE, FL 32244-1736
(904) 537-9701
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5228192
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PN5228192
LICENSE PRACTICAL NURSE
FL
Enumeration date
10/04/2018
Last updated
10/04/2018
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