Provider Demographics
NPI:1285275032
Name:TILLMAN, DIANA JEANNE (CNA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:JEANNE
Last Name:TILLMAN
Suffix:
Gender:
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4542 SEAWAY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3390
Mailing Address - Country:US
Mailing Address - Phone:970-308-6283
Mailing Address - Fax:
Practice Address - Street 1:113 CORONADO CT UNIT 51A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4911
Practice Address - Country:US
Practice Address - Phone:970-308-6283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
CO0026589225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator