Healthcare Provider Details

I. General information

NPI: 1699792200
Provider Name (Legal Business Name): TIMOTHY ALLEN VILES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 S TAMIAMI TRL
SARASOTA FL
34239-2219
US

IV. Provider business mailing address

965 FOXRIDGE LN
CARYVILLE TN
37714-3769
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-1250
  • Fax:
Mailing address:
  • Phone: 865-789-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9237953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: