Healthcare Provider Details

I. General information

NPI: 1730026857
Provider Name (Legal Business Name): TIMIKA IVORY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 COUNTRY CLUB DR UNIT 3208
TALLAHASSEE FL
32301-6631
US

IV. Provider business mailing address

2612 COUNTRY CLUB DR UNIT 3208
TALLAHASSEE FL
32301-6631
US

V. Phone/Fax

Practice location:
  • Phone: 850-815-8655
  • Fax:
Mailing address:
  • Phone: 850-815-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: