Healthcare Provider Details

I. General information

NPI: 1073602272
Provider Name (Legal Business Name): TOMMIE L. TIMMONS CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAKE CITY VA MEDICAL CENTER 619 S. MARION AVENUE
LAKE CITY FL
32025-5808
US

IV. Provider business mailing address

1424 NE WASHINGTON ST
LAKE CITY FL
32055-6571
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-3016
  • Fax: 386-758-6014
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: