Healthcare Provider Details

I. General information

NPI: 1508979246
Provider Name (Legal Business Name): JAMES R TIMKO M.A.,CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 N STONE ST STE 206
DELAND FL
32720-3208
US

IV. Provider business mailing address

844 N STONE ST STE 206
DELAND FL
32720-3208
US

V. Phone/Fax

Practice location:
  • Phone: 386-736-7192
  • Fax: 386-736-8520
Mailing address:
  • Phone: 386-736-7192
  • Fax: 386-736-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: