Individual
BRENT JUSTIN TILSETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 542-7300
Mailing address
5000 US HIGHWAY 17 STE 18-200, FLEMING ISLAND, FL 32003-8231
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME142293
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112609100
—
FL
01
—
O9423
MEDICARE PTAN OHRI
FL
01
—
PS650
MEDICARE PTAN OHMG
FL
01
—
XAEAA
BCBS
FL
Enumeration date
01/07/2014
Last updated
03/28/2023
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