Healthcare Provider Details

I. General information

NPI: 1558628974
Provider Name (Legal Business Name): TIMOTHY MICHAEL FOLEY APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

3150 N TENAYA WAY SUITE 140
LAS VEGAS NV
89128-0443
US

V. Phone/Fax

Practice location:
  • Phone: 702-562-5906
  • Fax:
Mailing address:
  • Phone: 702-240-2963
  • Fax: 702-240-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN001307
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: