Doctor Name: | MRS. SHELIA A SANCILLO TICE |
NPI Number: | 1255617973 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CFNP |
License Number: | R857901 |
Business Practice Address: | 1154 Cross Creek Dr Saltillo, MS - 388665777 |
Business Phone Number: | 6628408010 |
Business Fax Number: | 6628402656 |
Mailing Address: | 1154 Cross Creek Dr, SALTILLO |
State: | MS |
Postal Code: | 388665777 |
Phone Number: | 6628408010 |
Fax Number: | 6628402656 |
NPI Enumeration Date: | 10/26/2011 |
NPI Last Update Date: | 10/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | R857901 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |