IndividualActive
Caitlin Tillack, ANP
NPI 1124588660 · Gerontology Nurse Practitioner · Canandaigua, NY
Provider details
- NPI number
- 1124588660
- Entity type
- Individual
- Primary specialty
- Gerontology Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- ANP
- Sex
- Female
- Sole proprietor
- No
- License
- 309029 (NY)
Practice location
401 S Main St Ste 200
Canandaigua, NY 14424-2157
Phone: (585) 394-1875
Fax: (585) 394-1878
Mailing address
100 Kings Hwy S
Rochester, NY 14617-5504
Registry dates
- Enumerated
- 2019-03-21
- Last updated
- 2025-03-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.