Provider Demographics
NPI:1942083365
Name:TILLMAN, AMBER RACHELLE (FNP-C)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:RACHELLE
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760C NW BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-4102
Mailing Address - Country:US
Mailing Address - Phone:916-431-0236
Mailing Address - Fax:855-259-0680
Practice Address - Street 1:760C NW BROAD ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4102
Practice Address - Country:US
Practice Address - Phone:916-431-0236
Practice Address - Fax:855-259-0680
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018651363LF0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine