Provider Demographics
NPI:1770106783
Name:TILLEY, JENNIFER E (DNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:TILLEY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:7500 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2319
Mailing Address - Country:US
Mailing Address - Phone:855-524-4001
Mailing Address - Fax:402-398-5589
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2319
Practice Address - Country:US
Practice Address - Phone:855-524-4001
Practice Address - Fax:402-398-5589
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH158816363LA2100X
NE113144363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care