Healthcare Provider Details

I. General information

NPI: 1093418386
Provider Name (Legal Business Name): TLIMP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 TIMBERLOCH PL STE 200
THE WOODLANDS TX
77380-1182
US

IV. Provider business mailing address

17608 NORTHERN HARRIER CT
CONROE TX
77385-3843
US

V. Phone/Fax

Practice location:
  • Phone: 501-837-3680
  • Fax:
Mailing address:
  • Phone: 501-837-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE MICHELLE ELLISON
Title or Position: DOCTOR
Credential: MD
Phone: 501-837-3680