Individual
MS. PATRICIA SUE TILLACK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
9224 N 28TH ST, PHOENIX, AZ 85028-4705
(602) 510-6977
(602) 795-1442
Mailing address
9224 N 28TH ST, PHOENIX, AZ 85028-4705
(602) 510-6977
(602) 795-1442
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
186
AZ
Other
Enumeration date
04/29/2006
Last updated
07/08/2007
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