DR. SUWARNA M TILAK (NPI# 1174546584) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174546584 |
| Entity Type | Individual |
| Full Name | DR. SUWARNA M TILAK |
| Other Name | DR. SUE M TILAK |
| Credential | MD |
| Practice Address |
10175 Fortune Pkwy Suite 401 Jacksonville FL 32256-6746 |
| Mailing Address |
430 College Dr Suite 100-102 Middleburg FL 32068-8530 |
| Practice Telephone | 9045190008 |
| Practice Fax Number | 9045190007 |
| Mailing Telephone | 9042981994 |
| Mailing Fax Number | 9042981973 |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2009-11-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | ME71441 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | AETNA | 2941247 | 01 |
| FL | HUMANA | 05527 | 01 |
| FL | 250510000 | 05 | |
| FL | BCBS | 32326 | 01 |
| FL | AVMED | 211581 | 01 |
| Street Address |
10175 FORTUNE PKWY SUITE 401 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32256-6746 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730100587 | Mohammad Farooque | Psychiatry & Neurology | 10175 Fortune Pkwy, Suite #1106, Jacksonville, FL 32256-6746 | 2006-07-21 |
| 1902430614 | Delana Dampier | Technician | 10175 Fortune Pkwy, Jacksonville, FL 32256-6746 | 2020-03-03 |
| 1336780907 | Sunshine Medical Specialists, LLC | Pediatrics | 10175 Fortune Pkwy, Jacksonville, FL 32256-6746 | 2019-10-03 |
| 1376079905 | Ashley Raynor | Assistant Behavior Analyst | 10175 Fortune Pkwy, Suite 903, Jacksonville, FL 32256-6746 | 2017-05-02 |
| 1952834434 | Mollie Gibson | Assistant Behavior Analyst | 10175 Fortune Pkwy, Suite 903, Jacksonville, FL 32256-6746 | 2017-04-11 |
| 1720511728 | Desiree Adams | Assistant Behavior Analyst | 10175 Fortune Pkwy, Suite 903, Jacksonville, FL 32256-6746 | 2017-04-06 |
| 1538691555 | Meghan Rhegness | Assistant Behavior Analyst | 10175 Fortune Pkwy, Suite 903, Jacksonville, FL 32256-6746 | 2017-03-29 |
| 1568906048 | Alicia Miller | Assistant Behavior Analyst | 10175 Fortune Pkwy, Suite 903, Jacksonville, FL 32256-6746 | 2016-12-19 |
| 1417491036 | Mary Moore | Behavioral Analyst | 10175 Fortune Pkwy, Suite 903, Jacksonville, FL 32256-6746 | 2016-12-16 |
| 1720522352 | Lavyn Taylor | Assistant Behavior Analyst | 10175 Fortune Pkwy, Suite 903, Jacksonville, FL 32256-6746 | 2016-12-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841890464 | Alice Sanchez | Dietitian, Registered | 7643 Gate Parkway, Suite 104-1128, Jacksonville, FL 32256 | 2020-11-01 |
| 1093327702 | Oaktree Dental LLC | Clinic/Center | 14595 Philips Highway, Jacksonville, FL 32256 | 2020-08-24 |
| 1538787866 | Tywanna Council | Massage Therapist | 4720 Salisbury Road #102, Jacksonville, FL 32256 | 2020-07-13 |
| 1275155368 | Christy Orellana | Social Worker | 5011 Gate Parkway Bldg 100 Suite 100, Jacksonville, FL 32256 | 2020-05-11 |
| 1376175117 | Diane Stover | Case Manager/Care Coordinator | 7001 A. C. Skinner Parkway, Jacksonville, FL 32256 | 2020-02-10 |
| 1982235859 | Sandra Josefina Baez Nunez | Nurse Practitioner | 10739 Deerwood Park Blvd, Suite 200, Jacksonville, FL 32256 | 2020-01-30 |
| 1205476496 | Point Meadows Dental Center, Inc. | Dentist | 10915 Baymeadows Rd, #106, Jacksonville, FL 32256 | 2020-01-15 |
| 1598324113 | Dhaval Yogeshkumar Shah | Dentist | 8206 Philips Hwy., Suite 21, Jacksonville, FL 32256 | 2019-06-07 |
| 1003472499 | Dade Medical, Inc. | Durable Medical Equipment & Medical Supplies | 9143 Philips Highway Suite 270, Jacksonville, FL 32256 | 2019-05-13 |
| 1003479726 | Nichole Bashara | Behavior Technician | 8383 Baymeadows Rd, Jacksonville, FL 32256 | 2019-04-18 |
| Find all providers in zip 32256 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396369187 | Im Sulzbacher Center for The Homeless, Inc | Pediatrics | 5455 Springfield Blvd, Jacksonville, FL 32208-5166 | 2020-06-08 |
| 1609334515 | Jeremy N Harris, M.d., P.a. | Pediatrics | 3636 University Blvd S Ste B3, Jacksonville, FL 32216-4223 | 2019-03-10 |
| 1851856975 | Aksharbrahma Pa | Pediatrics | 6100 Greenland Rd Ste 301, Jacksonville, FL 32258-2626 | 2019-02-02 |
| 1184116972 | North Florida Pediatrics, Pa | Pediatrics | 9770 Old Bay Meadows Road, Suite 101, Jacksonville, FL 32256-7986 | 2018-06-06 |
| 1235654781 | Gabriella Assi, Md, LLC | Pediatrics | 5851 Saint Augustine Rd, Jacksonville, FL 32207-8015 | 2017-08-06 |
| 1417478629 | Johana Beatriz Gimenez | Pediatrics | 15 Founders Ln Ste 100, Jacksonville, IL 62650-3924 | 2017-06-28 |
| 1386185932 | Myrna B Ginter | Pediatrics | 3805 Ortega Blvd, Jacksonville, FL 32210-4415 | 2017-03-15 |
| 1831639400 | Children's Health Associates | Pediatrics | 3710 Grandy Ave, Jacksonville, FL 32207-6112 | 2017-03-02 |
| 1770039687 | Hampton Pediatrics Pa | Pediatrics | 11512 Lake Mead Ave Unit 201, Jacksonville, FL 32256-9688 | 2016-08-30 |
| 1447508478 | Starfish Pediatrics Pa | Pediatrics | 4500 Hodges Blvd, Suite 1, Jacksonville, FL 32224-2207 | 2012-08-23 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32256 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.