Healthcare Provider Details

I. General information

NPI: 1386263135
Provider Name (Legal Business Name): TRACY CAROL TIMQUE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MOUNT CARMEL AVE
HAMDEN CT
06518-1961
US

IV. Provider business mailing address

17 DANTE AVE
HICKSVILLE NY
11801-6305
US

V. Phone/Fax

Practice location:
  • Phone: 203-582-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: