Healthcare Provider Details

I. General information

NPI: 1114256732
Provider Name (Legal Business Name): TIMKO HEARING CARE, P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 DUNLAWTON AVE SUITE 103
PORT ORANGE FL
32127-2905
US

IV. Provider business mailing address

844 N STONE ST STE 206
DELAND FL
32720-3208
US

V. Phone/Fax

Practice location:
  • Phone: 386-756-8225
  • Fax: 386-767-0742
Mailing address:
  • Phone: 386-736-7192
  • Fax: 386-736-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberAY393
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberAY393
License Number StateFL

VIII. Authorized Official

Name: MR. JAMES ROBERT TIMKO
Title or Position: SOLE MEMBER
Credential: M.A., CCC-A
Phone: 386-736-7192