Provider Demographics
NPI:1265535579
Name:TILBE, SHARON ANNE (RD ND)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANNE
Last Name:TILBE
Suffix:
Gender:F
Credentials:RD ND
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:BERNIER
Other - Last Name:TILBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN ND
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1400
Mailing Address - Fax:239-424-1421
Practice Address - Street 1:708 DEL PRADO BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5616
Practice Address - Country:US
Practice Address - Phone:239-573-5741
Practice Address - Fax:239-574-0101
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4683133V00000X, 133V00000X
415900(RD)133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TI MT0635Medicare ID - Type Unspecified