Healthcare Provider Details

I. General information

NPI: 1881559409
Provider Name (Legal Business Name): TIMOTHY MICHAEL COOKERLY FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72140 MAGNESIA FALLS DR STE 1
RANCHO MIRAGE CA
92270-4941
US

IV. Provider business mailing address

72140 MAGNESIA FALLS DR STE 1
RANCHO MIRAGE CA
92270-4941
US

V. Phone/Fax

Practice location:
  • Phone: 760-699-7607
  • Fax: 760-699-7864
Mailing address:
  • Phone: 760-699-7607
  • Fax: 760-699-7864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95232157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: