Shaundria Tillman, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN5228192 Issued in FL

Practice address

5749 Tampico Rd
Jacksonville, FL 32244-1736

Phone

(904) 537-9701

NPI assigned

Oct 4, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1538611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1740755842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5749 TAMPICO RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322441736",
            "telephone_number": "904-537-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5749 TAMPICO RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322441736",
            "telephone_number": "904-537-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "SHAUNDRIA",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-04",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN5228192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE PRACTICAL NURSE",
            "identifier": "PN5228192",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Armika Tillman-Williams, RN
• Nancy T. Tillman, RN
• Noah Tillman, DC
• Shannon E Tillman, CMA
• Sharicka Michelle Tillman
• Toni Tillman
• Timothy H Tillo, D.P.M.
• Brent Justin Tilseth, M.D.
• Keval Tilva, MD
• Dan'N Ebby Khaelle Tima

• Licensed Practical Nurse in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Licensed Practical Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; 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.