Jacqueline D Gist-Tillman, REGISTERED NURSE

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

476472 Issued in NY

Practice address

510 Clermont Ave.
Room 211
Brooklyn, NY 11238

Phone

(718) 857-4646

NPI assigned

Apr 24, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1335225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335225600000",
    "number": "1801154141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 CLERMONT AVE",
            "address_2": "ROOM 211",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11238",
            "telephone_number": "718-857-4646",
            "fax_number": "718-857-0565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 CLERMONT AVE.",
            "address_2": "ROOM 211",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11238",
            "telephone_number": "718-857-4646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIST-TILLMAN",
        "first_name": "JACQUELINE",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-24",
        "last_updated": "2012-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "476472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annie Girton
• Heather R. Girvan, LCSW
• Lisann Marie Giscombe, NP
• John Gisondi Jr.
• Doreen Gissentanna
• Saubhagyini Gitel
• Ahuva Gitelis
• Ariella Gitelis, COTA
• Chaim Aryeh Gitelis, D.O.
• Rivka Gitelis, MS CCC-SLP

• Registered Nurse in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; 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.