Healthcare Provider Details

I. General information

NPI: 1063336105
Provider Name (Legal Business Name): TIMARA SIMONE BULLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 FLORIDA AVE NW APT 609
WASHINGTON DC
20001-5582
US

IV. Provider business mailing address

965 FLORIDA AVE NW APT 609
WASHINGTON DC
20001-5582
US

V. Phone/Fax

Practice location:
  • Phone: 202-491-5203
  • Fax: 202-491-5203
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: