=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588106934
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY ALLEN ROBERTS ARNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2016
-----------------------------------------------------
Last Update Date | 11/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 OLD CAMP RD STE 114
-----------------------------------------------------
City | THE VILLAGES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32162-5605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-259-4322
-----------------------------------------------------
Fax | 352-259-3882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 910 OLD CAMP RD STE 114
-----------------------------------------------------
City | THE VILLAGES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32162-5605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-259-4322
-----------------------------------------------------
Fax | 352-259-3882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP918240
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------