Healthcare Provider Details

I. General information

NPI: 1467104901
Provider Name (Legal Business Name): MERIAH FAITH TIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4685 S CONGRESS AVE
PALM SPRINGS FL
33461-4761
US

IV. Provider business mailing address

4685 S CONGRESS AVE
PALM SPRINGS FL
33461-4761
US

V. Phone/Fax

Practice location:
  • Phone: 561-548-2662
  • Fax: 561-548-1633
Mailing address:
  • Phone: 561-548-2662
  • Fax: 561-548-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number11017692
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11017692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: