Healthcare Provider Details

I. General information

NPI: 1184452856
Provider Name (Legal Business Name): TIMOTHY SANDERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 W BATES ST
PLANT CITY FL
33563-6423
US

IV. Provider business mailing address

1213 W BATES ST
PLANT CITY FL
33563-6423
US

V. Phone/Fax

Practice location:
  • Phone: 727-902-4340
  • Fax:
Mailing address:
  • Phone: 727-902-4340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: