Healthcare Provider Details

I. General information

NPI: 1508621962
Provider Name (Legal Business Name): CYNTHIA LEE TIMOK PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR STE S
HENRICO VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR STE S
HENRICO VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 804-713-6987
  • Fax: 804-430-3116
Mailing address:
  • Phone: 804-713-6987
  • Fax: 804-430-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024189499
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: