Provider Demographics
NPI:1053372045
Name:CLEMOW-TILLEY, ELIZABETH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:CLEMOW-TILLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5642
Mailing Address - Country:US
Mailing Address - Phone:561-401-5159
Mailing Address - Fax:
Practice Address - Street 1:1713 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9631
Practice Address - Country:US
Practice Address - Phone:772-324-5400
Practice Address - Fax:772-934-6342
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2784382363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1081ZMedicare ID - Type Unspecified
FLS62666Medicare UPIN