Active NPI
Stephanie Flynn Tilley, DMD
- Dentist
- Pensacola, FL
National Provider Identifier
1043392061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN15015
- Practice address
- 1295 W Fairfield Dr
Pensacola, FL 32501-1107 - Phone
- (850) 595-6417
- Fax
- (850) 595-6693
- NPI assigned
- Oct 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN15015 | FL | Primary |
Addresses
Primary practice location
1295 W Fairfield Dr
Pensacola, FL 32501-1107
Mailing address
1300 W Gregory St
Pensacola, FL 32501-3724
Phone (850) 595-6417
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150728003904 | FL | Order and Referring Only - Dentist | 5890009468 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043392061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 W GREGORY ST",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325013724",
"telephone_number": "850-595-6417",
"fax_number": "850-595-6693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1295 W FAIRFIELD DR",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325011107",
"telephone_number": "850-595-6417",
"fax_number": "850-595-6693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLEY",
"first_name": "STEPHANIE",
"middle_name": "FLYNN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN15015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pensacola, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.