Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tara Leann Tillman, FNP

Individual provider Family Nurse Practitioner · NPI 1245129030

Tara Leann Tillman, FNP is a Nurse Practitioner in Lucedale, Mississippi. Qualified in 2024, 2 years ago. Licensed in Mississippi.

Years since qualifying
2
Licensed in
MS
In the registry since
2025
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

See every abbreviation used in this directory →

Practice location Address checks out

103 W Frontage Rd
Lucedale, MS 39452-5836
Phone: (601) 947-9596
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 907184 (MS)

Record details

NPI number1245129030
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorNo
NPI enumeratedJune 28, 2025
Last updated in NPPESJuly 2, 2025
Certification dateJuly 2, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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