Healthcare Provider Details

I. General information

NPI: 1982649232
Provider Name (Legal Business Name): TIMOTHY PATRICK NUSS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5969 E BROAD ST 2ND FLOOR
COLUMBUS OH
43213
US

IV. Provider business mailing address

85 MCNAUGHTEN RD FL 2
COLUMBUS OH
43213-2174
US

V. Phone/Fax

Practice location:
  • Phone: 614-864-6010
  • Fax: 614-864-0306
Mailing address:
  • Phone: 614-627-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number06605
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: