Healthcare Provider Details

I. General information

NPI: 1538868955
Provider Name (Legal Business Name): TIMOTHY SCOTT ENFINGER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 02/24/2023
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MAGNOLIA BLUFF DR
GAUTIER MS
39553-1901
US

IV. Provider business mailing address

1400 MAGNOLIA BLUFF DR
GAUTIER MS
39553-1901
US

V. Phone/Fax

Practice location:
  • Phone: 228-300-1967
  • Fax:
Mailing address:
  • Phone: 228-300-1967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number905408
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: