Provider Demographics
NPI:1457948317
Name:TILGHMAN, CARNELLA (CNA 2, BLS PROVIDER,)
Entity type:Individual
Prefix:MS
First Name:CARNELLA
Middle Name:
Last Name:TILGHMAN
Suffix:
Gender:F
Credentials:CNA 2, BLS PROVIDER,
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:TILGHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2269 TRINITY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-7524
Mailing Address - Country:US
Mailing Address - Phone:252-560-1959
Mailing Address - Fax:
Practice Address - Street 1:2269 TRINITY CLUB DR
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-7524
Practice Address - Country:US
Practice Address - Phone:252-560-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94769376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide