Healthcare Provider Details

I. General information

NPI: 1912771791
Provider Name (Legal Business Name): KATY THIMANN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 SAINT JOHNS BLUFF RD S
JACKSONVILLE FL
32246-2310
US

IV. Provider business mailing address

2983 BARI CT
JACKSONVILLE FL
32246-5518
US

V. Phone/Fax

Practice location:
  • Phone: 904-481-8163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN9523875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: