MEDICARE: TIMOTHY ANDERSON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA03747	TX
2	363A00000X	Physician Assistant	PA 908641	FL

General Provider Information

NPI Number	:	1063496222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY ANDERSON PA

Provider Business Mailing Address
First Line	:	954 LAKE BALDWIN LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6651
Country	:	US
Telephone Number	:	407-478-9797
Fax Number	:	407-478-9798

Provider Business Practice Location Address
First Line	:	954 LAKE BALDWIN LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6651
Country	:	US
Telephone Number	:	407-478-9797
Fax Number	:	407-478-9798

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	08/09/2016

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Directions to “ TIMOTHY ANDERSON PA” Practice Location

Language	Start Address	Practice Location

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