Provider Demographics
NPI:1669697405
Name:TILLMAN, MARCIA (CRNP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1890 AL HIGHWAY 157
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-3601
Mailing Address - Country:US
Mailing Address - Phone:256-737-8000
Mailing Address - Fax:256-737-8058
Practice Address - Street 1:1890 AL HIGHWAY 157
Practice Address - Street 2:SUITE 300
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-3601
Practice Address - Country:US
Practice Address - Phone:256-737-8000
Practice Address - Fax:256-737-8058
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-035942363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care