Healthcare Provider Details

I. General information

NPI: 1083569446
Provider Name (Legal Business Name): TIMMEKA BERIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8661 N PORT WASHINGTON RD
FOX POINT WI
53217-2209
US

IV. Provider business mailing address

8661 N PORT WASHINGTON RD
FOX POINT WI
53217-2209
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-6836
  • Fax:
Mailing address:
  • Phone: 414-540-6836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1823933
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number233131-30
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1823933
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: