MEDICARE: MRS. TRACY C TIMMER FNP

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	363LF0000X	Family Nurse Practitioner	725460	TX

General Provider Information

NPI Number	:	1134333958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY C TIMMER FNP

Provider Business Mailing Address
First Line	:	6107 QUAIL FEATHER LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-4530
Country	:	US
Telephone Number	:	808-223-6635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 LONE STAR PASS STE 46
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78264-3650
Country	:	US
Telephone Number	:	210-263-5748
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	01/14/2014

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