Provider Demographics
NPI:1316978190
Name:TILLY, SARAH A (PA-C)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:A
Last Name:TILLY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:8101 E LOWRY BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7196
Mailing Address - Country:US
Mailing Address - Phone:303-344-9090
Mailing Address - Fax:303-344-1922
Practice Address - Street 1:8101 E LOWRY BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7196
Practice Address - Country:US
Practice Address - Phone:303-344-9090
Practice Address - Fax:303-344-1922
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-07-28
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Provider Licenses
StateLicense IDTaxonomies
CO2111363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27683354Medicaid
COQ50645Medicare UPIN
CO805939Medicare PIN
CO27683354Medicaid