Healthcare Provider Details

I. General information

NPI: 1669109930
Provider Name (Legal Business Name): TIMBERLIE JEANE ADAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIMBERLIE S BROOKS RN

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 COUNTRY RD 472
OXFORD FL
34484
US

IV. Provider business mailing address

149 KINGS BLVD
LEESBURG FL
34748-8933
US

V. Phone/Fax

Practice location:
  • Phone: 352-689-6400
  • Fax:
Mailing address:
  • Phone: 352-661-6409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number42175
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: