Provider Demographics
NPI:1144650805
Name:TILLEY, CELYA N (FNP-BC)
Entity type:Individual
Prefix:
First Name:CELYA
Middle Name:N
Last Name:TILLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 183432
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76096-3432
Mailing Address - Country:US
Mailing Address - Phone:817-907-5843
Mailing Address - Fax:
Practice Address - Street 1:3825 YUCCA AVE
Practice Address - Street 2:SUITE NUMBER #129
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-6067
Practice Address - Country:US
Practice Address - Phone:817-759-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-17
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX704818363LF0000X
TXAP124789363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner