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General NPI Number Information
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NPI Number | 1477315976
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Entity Type | Individual
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Provider Name | CHELSEA NOELLE MIRA TIMONERA PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 3140 S FALKENBURG RD STE 205
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City | RIVERVIEW
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State | FL
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Zip | 33578-2594
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Country | US
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Telephone | 813-533-5522
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Fax | 813-533-5511
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Provider Business Mailing Address
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Address Line | 3140 S FALKENBURG RD STE 205
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City | RIVERVIEW
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State | FL
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Zip | 33578-2594
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Country | US
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Telephone | 813-533-5522
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Fax | 813-533-5511
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9118451
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9118451
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License Number State | FL
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