Shannon E Tillman, CMA

Primary specialty

Adult CompanionTaxonomy code 372600000X

License

238705 Issued in FL

Practice address

3104 W 12TH St
Jacksonville, FL 32254-1808

Phone

(413) 686-2639

Fax

(904) 212-1996

NPI assigned

Jul 24, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ms. Shannon E Gibson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Medical Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1245965144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 ARLINGTON EXPY STE B105",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322110810",
            "telephone_number": "904-351-6479",
            "fax_number": "904-212-1996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3104 W 12TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322541808",
            "telephone_number": "413-686-2639",
            "fax_number": "904-212-1996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "SHANNON",
        "middle_name": "E",
        "name_prefix": "Mrs.",
        "credential": "CMA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-24",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "FL",
            "license": "238705",
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "FL",
            "license": "238705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "GIBSON",
            "middle_name": "E",
            "prefix": "MS.",
            "credential": "CMA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mallory Lynn Tillis, SLP
• Tina Nannette Tillis, MD
• Tiffany Armika Tillman-Williams, RN
• Nancy T. Tillman, RN
• Noah Tillman, DC
• Sharicka Michelle Tillman
• Shaundria Tillman, LPN
• Toni Tillman
• Timothy H Tillo, D.P.M.
• Brent Justin Tilseth, M.D.

• Adult Companion in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Adult Companion in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.