Healthcare Provider Details

I. General information

NPI: 1417400458
Provider Name (Legal Business Name): TIMOTHY HARTZLER AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4510
US

IV. Provider business mailing address

2369 STAPLES MILL RD STE 200
RICHMOND VA
23230-2918
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-8206
  • Fax: 804-320-3102
Mailing address:
  • Phone: 804-285-8206
  • Fax: 804-497-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0001215542
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024173738
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: