Healthcare Provider Details

I. General information

NPI: 1144840554
Provider Name (Legal Business Name): CODY TIMMER ACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26900 CEDAR RD
BEACHWOOD OH
44122-1191
US

IV. Provider business mailing address

26900 CEDAR RD
BEACHWOOD OH
44122-1191
US

V. Phone/Fax

Practice location:
  • Phone: 216-839-3900
  • Fax: 216-839-3910
Mailing address:
  • Phone: 216-839-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN.438679
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: